ABSTRACT BOOK - CYSTINET-Africa Conference...1 ABSTRACT BOOK Arusha - Tanzania CYSTINET-Africa: Cysticercosis/Taeniosis Conference 2019 26-28 November 2019 MOZAMBIQUE INSTITUTE FOR

1

ABSTRACT BOOK

Arusha - Tanzania

CYSTINET-Africa: Cysticercosis/Taeniosis Conference 2019

26-28 November 2019

MOZAMBIQUE INSTITUTE FOR HEALTH EDUCATION AND RESEARCH UNIVERSIDADEE D U A R D O

MONDLANE

PARTNERS

Technische Universitat Munchen .. .. Klinikum rechts der IsarCystinet Abstract Book - Final.indd 1 22/11/2019 15:39

2

Cystinet Abstract Book - Final.indd 2 22/11/2019 15:39

3

ABSTRACT BOOK

Arusha - Tanzania


26-28 November 2019

MOZAMBIQUE INSTITUTE FOR HEALTH EDUCATION AND RESEARCH UNIVERSIDADEE D U A R D O

MONDLANE

PARTNERS

Technische Universitat Munchen .. .. Klinikum rechts der Isar

Morogoro, Tanzania

Dar Es Salaam, Tanzania

Lusaka, Zambia Maputo, Mozambique

Munich, Germany

The University of Zambia Mozambique Institute for Health Education and Research/Eduardo Mondlane University

Technical University of Munich

Sokoine University of Agriculture

National Institute for Medical Research


4


TABLE OF CONTENTS

• Message from the Organisers 1

• BackgroundInformation 4

• Conference Programme 6

• ProfilesofInvitedSpeakers 9

• Abstracts–OralPresentations 15

• Abstracts–PosterPresentations 52


1

WELCOME MESSAGE FROM THE CHAIR – CONFERENCE ORGANIZING COMMITTEE

Dear Friends and Colleagues, On behalf of CYSTINET-Africa and the Conference Organizing Committee it is my pleasure to welcome you all to this conference on “Taenia Solium Cysticercosis/Taeniosis (TSCT) - From Research To Policy.”

This is an internationally unprecedented event dedicated not only to recent advances in research but also to integrated knowledge translation into policy and practice. It provides an interactive forum,

which brings together international and local researchers, policymakers, implementers, students as well as national and international stakeholders involved in the control and elimination of TSCT - across different disciplines - for scientific exchanges and debates on the diverse aspects of cysticercosis/taeniosis in Africa and beyond. I am especially proud that we were able to secure the attendance of the Minister of Health of the Republic of Tanzania and other high-level officials who will open our conference. The Conference Organizing Committee has prepared an interesting program covering topics from epidemiological, immunological and clinical aspects of TSCT to control and prevention as well as policy implementation in plenary sessions and workshops. Our keynote speakers include colleagues with great expertise and global knowledge of the various aspects of TSCT. It is an honor for me to be appointed as chair for this process and work with a wonderful and dedicated team, ensuring the best results for this conference. Successfully organizing this conference has required the talents, dedication and time of colleagues across different sites (please see list above). It is our hope that you will find the conference enjoyable and valuable. Please also find time to explore the beautiful and majestic city of Arusha. I particularly warmly welcome students from Africa and other parts of the world, who are joining us. We have designed some sessions that we believe will be especially beneficial for the students. You are most welcome and we hope this will be a great learning and networking experience for you. I would like to express gratitude to our sponsor, the German Federal Ministry of Education and Research (BMBF), for the funding of the CYSTINET-Africa project. Many thanks to our implementing authorities; GIZ and DLR for their guidance and support. Special thanks to our partners; Technical University of Munich, University of Zambia, Sokoine University of Agriculture, National Institute for Medical Research Muhimbili Research Centre, and Eduardo Modale University for their support and dedication to organizing this conference. Once again, I welcome you to this conference and to Arusha - Tanzania! Karibu Sana!

Dr. Bernard James Ngowi, MD, PhD Chair – Conference Organizing Committee

National Institute for Medical Research (NIMR) Muhimbili Research Centre-Dar es Salaam, Tanzania

Dr. Bernard James Ngowi, MD, PhDChair–ConferenceOrganizingCommittee

NationalInstituteforMedicalResearch(NIMR)MuhimbiliResearchCentre-DaresSalaam,Tanzania

Mobile:+255763918181,E-mail:[email protected]


2

Conference Scientific Committee

• Dr. Bernard Ngowi — National Institute for Medical Research Dar es Salaam, Tanzania • Prof. Dr. Helena Ngowi —Sokoine University of Agriculture, Morogoro, Tanzania • Prof. Dr. Dr. Andrea Winkler — Department of Neurology, Klinikum rechts der Isar,

Technical University Munich, Germany • Prof. Dr. Clarissa Prazeres da Costa — Institute for Medical Microbiology, Immunology and

Hygiene, Technical University Munich, Germany • Mag. Veronika Schmidt — Department of Neurology, Klinikum rechts der Isar, TUM,

Germany • Dr. Chummy Sikasunge — University of Zambia, Lusaka, Zambia • Prof. Dr. Emilia Noormahomed —Eduardo Mondale University, Maputo, Mozambique • Prof. Dr. Isaac Phiri — University of Zambia, Lusaka, Zambia • Prof. Dr. Sayoki Mfinanga — National Institute for Medical Research, Dar es Salaam,

Tanzania • Dr. Ernatus Mkupasi — Sokoine University of Agriculture, Morogoro, Tanzania • Dr. Charles Makasi — National Institute for Medical Research, Dar es Salaam, Tanzania • Dr. Kabemba E. Mwape — University of Zambia, Lusaka, Zambia • Dr. Fabien Prodjinotho — Institute for Medical Microbiology, Immunology and Hygiene,

Technical University Munich, Germany • Dr. Noémia Nhancupe — Eduardo Mondale University, Maputo, Mozambique • Dr. Andrew Martin Kilale — National Institute for Medical Research, Dar es Salaam,

Tanzania

Conference Organization Committee

• Dr. Bernard Ngowi Chairperson • Mr. Antony Nyerere Secretary • Prof. Helena Ngowi Co-Chairperson • Prof. Andrea Winkler Co-Chairperson • Mag. Veronika Schmidt Member • Dr. Fabien Prodjinotho Member • Dr. Felix Sukums Member • Dr. Andrew Martin Kilale Member • Dr. Ernatus Mkupasi Member • Dr. Ayubu Churi Member • Mr. Asanali Msangi Member • Ms. Christina Kitundu Member • Dr. Felix Sukums IT/Conference Website Lead • Dr. Jan Knobloch IT/Conference Website Co-Lead • Mr. Patrick Mbughuni Finance Lead • Mr. Mbangula Tulinagwe Finance Co-Lead


3

4

Conference Organizing Support Team/International experts

• Ms. Annette Abraham Adviser Conference Organization Issues, Technical University of Munich

• Ingeborg Haavardsson Adviser Conference Organization Issues, University of Oslo

• Dr. Dominik Stelzle Advisor Conference Organization Issues, Technical University of Munich

• Mr. Yunus Karsan ICT support, Sokoine University of Agriculture

Conference Exhibition Committee

• Dr. Andrew Martin Kilale National Institute for Medical Research, Dar es Salaam • Mr. Antony Nyerere Sokoine University of Agriculture, Morogoro


4

CYSTINET-Africa BACKGROUND INFORMATION

CYSTINET-Africa stands for Cysticercosis Network of Sub-Saharan Africa

Taenia solium cysticercosis/taeniosis/neurocysticercosis (TSCT/NCC) is a neglected infectious disease which can be controlled and subsequently eliminated. It is endemic in many sub-Saharan countries. The disease affects human and animal health alike and thus has socio-economic effects on affected countries. The cysticercosis research network CYSTINET-Africa, which is based on the One-Health concept, that connects human, animal and environmental (e.g. community) health for the effective management of infectious diseases, is set up to contribute to elimination and prevention of TSCT/NCC. CYSTINET-Africa consists of four African partner institutions (Sokoine University of Agriculture, Morogoro, Tanzania; National Institute for Medical Research, Dar es Salaam Tanzania; University of Zambia, Lusaka, Zambia; and Eduardo Mondlane University, Maputo, Mozambique) and two German partners at the Technical University of Munich and has defined the following objectives: - study of the immunological pathomechanisms of TSCT in immunocompetent and

immunocompromised people; - implementation of treatment strategies especially against the background of the African HIV

epidemic; - intensive epidemiological work-up of the local endemic situation to allocate appropriate

resources and improve disease management as well as prevention; - development of a low-cost locally-adapted health education package for TSCT; - intensive network cooperation to promote capacity building at national and international

levels; - implementation of institutional and systemic structures including the establishment of a

Virtual One-Health Centre. The project is funded by the German Federal Ministry of Education and Research (BMBF) to facilitate world-class and interdisciplinary research on poverty-related and neglected diseases. In addition, the funding initiative also aims at increasing the capacity of North-South and South-South research collaborations to produce locally relevant and useful research which will contribute to achieving the Sustainable Development Goals, especially Goal 3. Therefore, the design of this conference reaches from basic sciences via epidemiology to disease management/prevention emphasizing research that is relevant to the local and regional needs of African partners and that is conducted in true partnership. The conference also sheds light on policy generation/implementation as well as other cross-cutting issues such as One-Health and digital health.


5

6

The First International CYSTINET-Africa Conference, November 26-28, 2019

The Conference will be held at the Mount Meru Hotel Arusha, Tanzania in Arusha, Tanzania. The conference has already attracted registration of various delegates from Tanzania, Zambia, Mozambique, Germany, Norway, the United Kingdom and other countries around the world. The main theme is “Taenia solium Cysticercosis/Taeniosis (TSCT) — From Research to Policy”. The conference will run five plenary sessions addressing the following sub-themes:

1) Epidemiology and Burden of TSCT 2) Basic and Immunological Aspects of TSCT 3) Diagnostic and Clinical aspects of TSCT and Case Management 4) Control and Prevention of TSCT 5) Policy Generation and Implementation and other Cross-cutting Issues

Three symposia will also be held during the 3-day conference: video-recording of scientific lectures, how to conduct a scientific review and what mentoring is all about. For each sub-theme, speakers will deliver a keynote address (as shown below):

Keynote 1: Epidemiology and Burden of TSCT (Prof. Hélène Carabin) Keynote 2: Basic and Immunological Aspects of TSCT (Prof. Agnès Fleury) Keynote 3: Diagnostic and Clinical Aspects of TSCT and Case Management (Prof. Héctor H. Garcia) Keynote 4: New Development in the Diagnosis of TSCT (Prof. Sarah Gabriël) Keynote 5: Control and Prevention of TSCT (Prof. Arve Lee Willingham) Two lead papers focusing on cross-cutting issues and future prospects in the control of Cysticercosis/Taeniosis in Sub-Saharan Africa will be presented:

1) Policy Generation and Implementation and other Cross-cutting Issues (Prof. Japhet Killewo)

2) Cysticercosis Working Group in Eastern and Southern Africa (CWGESA): Past, Present and Future Directions (Prof. Samson Mukaratirwa)


6

CONFERENCE PROGRAMME AT A GLANCE

Pre-conference workshop on video-recording of scientific lectures, 25th November 2019

Day 1, 26th November 2019

Serial No Opening Ceremony 08:00-10:40 Registration Arrival of delegates 08:00-09:00 Opening session Minister of Health of the Republic of Tanzania 09:00-10:20 Opening session Director General National Institute of Medical Research 09:00-10:20 Opening session Vice Chancellor Sokoine University of Agriculture 09:00-10:20 Opening session Regional Medical Officer of Arusha 09:00-10:20 Opening session Chair Conference Organizing Committtee 09:00-10:20 Group photos All 10:20-10:40 Nutrition break 10:40-11:00 A Epidemiology and Burden of Cysticercosis/Taeniosis Keynote Prof. Hélène Carabin 11:00-11:30 Session Chairs: Prof. Helena Ngowi, Prof. Hélène Carabin 11:30-12:50

1

Modelling Taenia solium interventions for post 2020 NTD targets: the impact of varying slaughter age and identification of minimum intervention coverages for pig and human intervention strategies

Matthew A. Dixon, Peter Winskill, Maria-Gloria Basáñez

2 Seroprevalence and risk factors of human cysticercosis in Mocuba district, Central Mozambique: A pilot study

Irene Langa, Fernando Padama, Alberto Pondja, Hélène Carabin, Iva Chirrime, Noémia Nhancupe, Lucas Banze, Lidia Gouveia, Clarissa Prazeres da Costa, Veronika Schmidt , Andrea Winkler, Emilia Noormahomed

3 Prevalence of cysticercosis in pork entering the food chain in Rwanda

Anselme Shyaka, Nadine Rujeni, Eric Fèvre, Rupert Quinnell

8

4 Mapping occurrence of Taenia solium taeniosis/cysticercosis and areas at risk of porcine cysticercosis in Central America and the Caribbean basin

Uffe Christian Braae, Brecht Devleesschauwer, Fortune Sithole, Ziqi Wang, Arve Lee Willingham

Panel Discussion

Lunch break and poster viewing 12:50-13:45 B1 Diagnostic and Clinical Aspects of Cysticercosis/Taeniosis and Case Management

Keynote Prof. Héctor H. Garcia 13:45-14:15 Session I Chairs: Prof. Andrea Winkler, Prof. Héctor H. Garcia 14:15-15:45

1 The prevalence of neurocysticercosis among cysticercosis positive individuals and characterization of associated clinical symptoms

Gideon Zulu, Wilbroad Mutale, Dominik Stelzle, Kabemba Mwape, Chummy. S. Sikasunge, Veronika Schmidt, Chishimba Mubanga, Isaac Phiri, Andrea Winkler

2 Epidemiology and clinical characteristics of (neuro)cysticercosis patients in Europe

Annette Abraham, Dominik Stelzle, Miriam Kaminski, Veronika Schmidt, Carmen Cretu, Sarah Gabriël, Javier Bustos, Robert Meijere, Priyadarshi Soumyaranjan Sahu, Héctor Garcia, Andrea Winkler

3 Clinical and imaging features of patients with epilepsy and its association with neurocysticercosis in patients from Mocuba District, Zambézia Province, Mozambique: preliminary results

Fernando Padama, Irene Langa, Noémia Nhacumpe, Alberto Pondja, Emilia Noormahomed

4 Patients with severe manifestation of active neurocysticercosis from southern Tanzania: a case series

Dominik Stelzle, Charles Makasi, Charlotte Rüther, Gideon Zulu, Emmanuel Bottieau, Veronika Schmidt, Sarah Gabriël, Bernard Ngowi, Andrea Winkler

Panel Discussion Evening Tea 15:45-16:20

B2 Diagnostic and Clinical aspects of Cysticercosis/Taeniosis and Case Management Keynote Prof. Sarah Gabriël 16:20-16:50 Session II Chairs: Dr. Bernard Ngowi, Prof. Sarah Gabriël 16:50-18:10

1 Accurate and sensitive assessment of porcine cysticercosis at post-mortem

Marshall Lightowlers

2 Application of droplet digital Polymerase Chain Reaction for the detection and absolute quantification of Taenia solium eggs in soil

Justine Maganira, Beda Mwang'ondea, Winifrida Kidimab, Chacha Mwitac, Johan Höglundd

9

3 Patients' perceptions on the acceptability of a prototype point of care test for human taeniasis and cysticercosis diagnosis in Mbeya and Songwe regions, Tanzania

Emil Thomas, Hezron E. Nonga, Bernard Ngowi, Maria Vang Johansen, Sarah Gabriel, Helena. Ngowi, Pascal Magnussen

4 Evaluation of the accuracy of serologic tests in the diagnosis of neurocysticercosis with CT scan as gold standard in the district of Mocuba, Zambezia-Mozambique

Lucas Banze , Irene Langa, Fernando Padama, Emilia Noormahomed

Panel Discussion Systematic Literature Review Workshop (for CYSTINET-Africa students mandatory) 18:15-19:30


Serial No Topic Presenter Time

C Basic and Immunological Aspects of Cysticercosis/Taeniosis Keynote Prof. Agnès Fleury 08:30-09:00 Session II Chairs: Prof. Prazeres da Costa, Prof. Agnès Fleury 09:00-10:35

1 The immune system response in HIV patients with Taenia solium neurocysticercosis from Southern Highlands, Tanzania

Yakobo Lema, Fabien Prodjinotho, Eligius Lyamuya, Hélène Carabin, Andrea S. Winkler, Mkunde Chachage, Bernard Ngowi, Clarissa Prazeres da Costa

2 Taenia solium neurocysticercosis infection: understanding the immune regulation and pathogenesis from in vitro investigation

Fabien Prodjinotho, Veronika Schmidt, Chummy Sikasunge, Andrea Winkler, Clarissa Prazeres da Costa

3 Sero-epidemiology of human and porcine cysticercosis in Rwanda: a country-wide survey

Nadine Rujeni, Anselme Shyaka, Eric Fèvre, Rupert Quinnell

4 TSOL18 vaccine and oxfendazole for control of Taenia solium cysticercosis in pigs: A field trial in rural areas of Tanzania

Mwemezi Kabululu, Helena Ngowi, James Mlangwa, Ernatus Mkupasi, Uffe Braae, Angela Colston, Claudia Cordel, Elizabeth Poole, Maria Vang Johansen

5 Field trial to evaluate the safety and efficacy of cysvax™ recombinant porcine cysticercosis vaccine in pigs kept under field conditions in Tanzania

Asanteli Makundi, Angie Colston, Claudia Cordel, Rajendra Lingala, Munish Kumar, Satheesh Periasamy, Jane Poole, Jeremy Salt

9




















7

9



















10

Panel Discussion Nutrition break 10:35-10:55 D Control and Prevention of Cysticercosis/Taeniosis Keynote Prof. Arve Lee Willingham 10:55-11:25 Session Chairs: Dr. Chummy Sikasunge, Prof. Arve Lee Willingham 11:25-12:45

1 Taenia solium taeniosis and cysticercosis burden and potential for control in Tanzania: Twenty-three years research synthesis

Helena Ngowi, Andrea Winkler, Uffe Braae, Robinson Mdegela, Ernatus Mkupasi, Mwemezi Kabululu, Faustin Lekule, Maria Vang Johansen

2 Control of porcine cysticercosis and taeniasis: a qualitative assessment of possible control strategies using a theory of change approach

Nicholas Ngwili, Lian Thomas, Raphael Wahome, Samuel Githigia, Nancy Johnson, Kristina Roesel

3 Open defecation free status alone, not enough for the control of porcine cysticercosis

Kabemba Mwape, Chummy Sikasunge, Amos Chota, Isaac Phiri, Mwelwa Chembensofu, Pierre Dorny and Sarah Gabriël

4 A strategic approach to combining pig and human interventions for control of Taenia solium

Meritxell Donadeu

Panel Discussion Lunch break and poster viewing 12:45-13:45

E1 Policy Generation and Implementation and other Cross-cutting Issues Keynote Prof. Japhet Killewo 13:45-14:15 Session Chairs: Prof. Isaac Phiri, Prof. Japhet Killewo 14:15-15:00

1 Community practices related to epidemiology of Taenia solium in Iringa Rural District, Tanzania

Flora Kajuna, Beda Mwang’onde, Christine Holst, Bernard Ngowi, Andrea Winkler, Helena Ngowi, Josef Noll

2 Pig cysticercosis and risk perception among pork consumers in Dar es Salaam

Godwin Minga, Denis Kalabi, Henry Magwisha

3 Knowledge and practices related to human Taenia solium infections in Kongwa District, Dodoma region, Tanzania

George Makingi, Ernatus Mkupasi, Bernard Ngowi, Johashi Nzalawahe, Helena Ngowi

Evening Tea 15:00-15:45 Session continued 15:45-17:10

4 Knowledge and practices on porcine cysticercosis among smallholder pig farmers in Kongwa district, Tanzania

Christina Wilson, Hezron Nonga, Robinson Mdegela, Ernatus Mkupasi, Helena Ngowi

5 Influence of Human and Environmental Factors in the Transmission of Taenia Solium Cysticercosis in Villages of Alfred

Msawenkosi Sithole, Johan L Bekker, Samson Mukaratirwa

11

Nzo and or Tambo Districts of the Eastern Cape Province, South Africa

6 Adoption, users experience and effectiveness of The Government of Tanzania-Hospital Management Information System in a primary healthcare facility in Tanzania

Edward Lengai, Felix Sukums

7 Effect of cysticercosis education on improving the knowledge, attitudes, and intentions towards persons with epilepsy in Burkina Faso

Ellen Jackson, Veronique Dermauw, Athanase Millogo, Rasmané Ganaba, Helena A Ngowi, Pierre Dorny, Hélène Carabin

Panel Discussion Mentoring Workshop (for CYSTINET-Africa students mandatory) 17:10-18:30 Conference Dinner 19:30-22:00



E2 Policy Generation and Implementation and other Cross-cutting Issues Keynote Prof. Samson Mukaratirwa 09:00-09:30 Session Chairs: Prof. Sayoki Mfinanga, Prof. Samson Mukaratirwa 09:30-10:45 1 New WHO Roadmap for Taenia solium control Bernadette Abela-Ridder, Meritxell Donadeu

2 Integration mechanisms in human and animal health surveillance systems: challenges and opportunities in addressing global health security threats - a systematic review

Janeth George, Irene Mremi, Barbara Häsler, Calvin Sindato, Leonard Mboera, Mark Rweyemamu, James Mlangwa

3 Community-based interventions for the control of Taenia solium taeniasis and cysticercosis

Yewubdar Gulelat, Annie Cook, Tadesse Eguale

4 Networking the networks for the future of Global Health Andrea Winkler, Bernard Ngowi, Chummy Sikasunge, Helena Ngowi

Panel Discussion

11















Panel Discussion


8

11















Panel Discussion

12

Nutrition break 10:45-11:05 F Digital Health Mini-keynote Felix Sukums 11:05-11:20 Session Chairs: Prof. Bernd Brügge, Felix Sukums 11:20-12:35

1 Digital health information in Iringa, Tanzania: development, provision and testing the effect of digital cysticercosis/taeniosis messages on rural communities

Christine Holst, Flora Kajuna, Helena Ngowi, Felix Sukums, Danica Radovanovic, Wisam Mansour, Elibariki Mwakapeje, Lien My Diep, Tewodros Aragie Kebede, Ghislain Maurice Isabwe, Josef Noll, Bernard Ngowi, Andrea Winkler

2 The “Vicious Worm”: can the Taenia solium health education tool be used among meat inspectors and slaughterhouse workers in Zambia?

Victor Vaernewyck, Kabemba Mwape, Chishimba Mubanga, Isaac Phiri, Pierre Dorny, Sarah Gabriel, Chiara Trevisan

3 Creation of online videos for the Virtual One Health Center: a report of CYSTINET-Africa, a multidisciplinary research consortium for Taenia solium taeniosis/cysticercosis

Jan Knobloch, Veronika Schmidt, Bernard Ngowi, Chummy Sikasunge, Clarissa Prazeres da Costa, Helena Ngowi, Bernd Brügge, Andrea Winkler

4 Mobile phone data for helping control epidemics Stefania Rubrichi, Erwan Le Quentrec Panel Discussion G Closing Ceremony and Poster Award Closing Ceremony 12:35-13:00

Yvonne Schönemann, GIZ, Project Implementing Authority Bernard Ngowi, Chair Conference Organizing Committee Helena Ngowi, Director CYSTINET-Africa

Hezron Nonga, Director of Veterinary Service, Ministry of Livestock and Fisheries

Lunch 13:10-14:00 CYSTNET-Africa Executive Board Meeting 14:15-18:00

Closing Ceremony and Awards

CYSTINET-Africa Executive Board Meeting


9

PROFILESOF

INVITED SPEAKERS


10

Guest of Honor

Hon. Dr. Faustine Ndugulile (MP)

Dr. Faustine Ndugulile received his Doctor of Medicine degree from the University of Dar es Salaam, Tanzania in 1997, a Master of Medicine in Microbiology and Immunology in 2001 from the same university and a Master of Public Health degree from the University of Western Cape, South Africa in 2010.

Dr. Ndugulile was first elected to Parliament in 2010 and got re-elected for a second term in 2015. He has previously served as the Vice Chairman of the Parliamentary Social Services Committee and chair of the HIV/AIDS committee. Dr. Ndugulile is also the Chairman of the International Parliamentary Union (IPU) Advisory Group on

HIV/AIDS and Maternal, Newborn and Child Health; founding member of the Global Parliamentary TB Caucus and former Governing Council member of the International AIDS Society (IAS).

Dr. Ndugulile has been actively engaged in a number of initiatives related to HIV/AIDS, Maternal and Child Health and Sexual and Reproductive Health and Rights in Tanzania and Globally. He is currently saving as the Deputy Minister for Ministry of Health, Community Development Gender, Elderly and Children since October, 2017.

Prof. Dr Sarah Gabriël

Sarah Gabriël graduated as a veterinarian from Gent University in 1999. She first worked at the Onderstepoort Veterinary Institute in South Africa on anthelmintic resistance in sheep, where after she moved to the University of Zambia for five years, conducting research on Schistosoma spp. and foodborne parasites. Subsequently, she worked for three years on a cattle ranch in Gabon and returned to Belgium in 2008 to conduct research at the Institute of Tropical Medicine on foodborne parasitic zoonoses. Since October 2016 she is head of the Laboratory of Foodborne Zoonoses, Department of Veterinary Public Health and Food Safety, Ghent University, Belgium,

where her research focusses on Taenia solium, Taenia saginata, Anisakidae and Sarcocystis spp, covering diagnostics, epidemiology and control.

(Guest of Honor)


11

Héctor H. García (M.D., Ph.D.) is the director of the Center for Global Health in Tumbes and professor of the department of microbiology at the Universidad Peruana Cayetano Heredia, as well as head of the cysticercosis unit at the Instituto Nacional de Ciencias Neurologicas in Lima, Peru. Dr. García has a long history in global health research and training, including the successful direction of a 10 year cysticercosis elimination program in northern coastal Peru, which was funded by the Bill & Melinda Gates Foundation. He leads the Cysticercosis Working Group

in Peru, a multi-institutional group working in varied aspects of cysticercosis research that offers hands-on training in global health research to local scientists and health professionals. His lab has over 300 peer-reviewed publications as a result of research in diverse subjects of public health importance in Peru. Dr. García is the primary author of two trendsetting studies on cysticidal treatment for neurocysticercosis. Cysticidal drugs, namely albenzadole and praziquantel, destroy brain cysts. Dr. García’s studies examined the clinical benefits of these drugs and showed that combining them increases the destruction of brain cysts without increasing side effects, improving treatment and long-term prognosis for patients with neurocysticercosis.

Prof. Dr. Héctor H. García


12

Dr. Arve Lee Willingham

Dr. Arve Lee Willingham worked amongst others at the World Health Organization’s SpecialProgram for Tropical Diseases Research and Training (TDR) based in Geneva, Switzerland where he facilitated identification and prioritization of global research needs for helminth and zoonotic diseases as well as for the thematic area of the environment, agriculture and infectious diseases, and assisted in initiating TDR’s new research program on environmental and climate change impacts on vector-borne diseases. He currently lives in the West Indies where he serves as the Associate Dean for Research and Postgraduate Studies and Professor of One Health at Ross University School of

Veterinary Medicine (RUSVM) on the Caribbean island of St Kitts. He was the inaugural Director of RUSVM’s One Health Center for Zoonoses and Tropical Veterinary Medicine and recently served as President of the Central American and Caribbean Association for Parasitology and Tropical Medicine, hosting the Association’s 14th biennial congress on St. Kitts in July, 2019.

Prof. Samson Mukaratirwa

Prof. Mukaratirwa is holder of DVM, MVSc (Veterinary Parasitology) and a PhD (Parasitology) qualification. He attained the rank of Full Professor in 2003 at the University of Zimbabwe and currently a Professor of Parasitology at the School of Life Sciences, College of Agriculture, Engineering and Sciences, University of KwaZulu-Natal, a post he has held since 2007. He was previously the Head of School of Biological and Conservation Sciences, University of KwaZulu-Natal (2009-2011) before becoming the inaugural Dean of School of Life Sciences, a merger

with the School of Biochemistry, Genetics and Microbiology to form the current School of Life Sciences during the University reconfiguration to a College system. Before moving to the University of KwaZulu-Natal, he had occupied the post of Dean of Faculty of Veterinary Science, University of Zimbabwe for 8 years (2000-2007). His main research interest is in a variety of tropical parasitic diseases of economic and public health importance and has a passion on "Neglected Parasitic Zoonoses" affecting the resource-poor communities in Africa which includes malaria, schistosomiasis, Taenia solium cysticercosis, fasciolosis and trichinellosis. He is a prolific researcher in the field of veterinary and medical parasitology and has published more than 150 articles in peer-reviewed journals and has successfully supervised PhD and more than 25 MSc students in parasitology.


13

21

Prof. Japhet Killewo

Japhet Killewo is an emeritus professor of Epidemiology at the Muhimbili University of Health and Allied Sciences in Tanzania. He is currently Focal Person (Human Health) of the One Health East and Central Africa (OHCEA) Network which has its headquarters in Kampala, Uganda. As a teacher and researcher his interests are in communicable and non-communicable diseases and reproductive health. During 1999 to 2003 he worked with the International Centre for Diarrhoeal Disease Research in Bangladesh monitoring and evaluating reproductive health interventions in a health and demographic surveillance system. Since 2010 JK initiated an urban based health and demographic surveillance system in Tanzania where

more than 100,000 residents of all ages are being followed up for in- and out-migration, vital events, socio-economic status, non-communicable diseases (NCDs) of various kinds and food insecurity issues. JK has published widely (over 100 publications) in local as well as international journals and has written chapters in books and edited a section in the International Encyclopaedia of Public Health.


14

Morogoro, Tanzania



Munich, Germany






15

ABSTRACTSORAL PRESENTATIONS


16

22

Day 1, Tuesday 26th November 2019

A. Epidemiology and Burden of Cysticercosis/Taeniosis

Keynote Prof. Hélène Carabin

Presentations:

1. Title: Modelling Taenia solium interventions for post 2020 NTD targets: the impact of varying slaughter age and identification of minimum intervention coverage for pig and human intervention strategies

Authors: Dixon, M. A., Winskill, P. and Basáñez, M.

Abstract

Taeniosis and cysticercosis, which is caused by the cestode, Taenia solium, is a zoonotic neglected tropical disease (NTD) responsible for a significant global public health and economic burden. According to the proposal of the 2012 World Health Organization (WHO) roadmap on NTDs, by 2015, a validated strategy should be available for the control and elimination of T. solium taeniosis/cysticercosis and that, by 2020, appropriate control and elimination interventions should be scaled up in selected countries. With the targets now set for a review at post 2020 NTD control efforts, a validated strategy for T. solium control is yet to be identified. It is likely, however, that the intervention strategies will need to be tailored to specific settings and age at which the pigs are slaughtered as one of the important socio-cultural factors. ‘Minimal’ interventions have thus been proposed in the porcine host whereby treatment is only implemented to a certain age-limit, after which the pigs are slaughtered. Another important component that defines a validated strategy is the quantification of the minimum fraction (or intervention coverage), which is required to achieve a specified reduction of prevalence (representing achieving ‘intensified T. solium control).

A human and pig age-structured deterministic compartmental model (EPICYST) has been developed, with realistic pig demographics, which are incorporated to capture slaughtering practices. This allows further field-accurate implementation of interventions such as age targeting specific porcine age groups for treatment/vaccination and testing of ‘minimal’ intervention strategies in the porcine host. We present the modelling results to demonstrate a) the influence of the minimum slaughter age on the timelines in achieving the reductions in pig cysticercosis prevalence (e.g. to 1%) and b) minimum intervention coverages required to achieve these prevalence reductions for a range of field-realistic interventions (including ‘minimal’ pig-directed interventions vs. those applied to all ages).


17

23

2. Title: Seroprevalence and risk factors of human cysticercosis in Mocuba District, Central Mozambique: A pilot study

Authors: Langa, I., Padama, F., Pondja, A., Carabin, H., Chirrime, I., Nhancupe, N., Banze, L., Gouveia, L., Prazeres da Costa, C., Schmidt, V., Winkler, A. S. and Noormahomed, E.

Abstract

Introduction: Taenia solium cysticercosis constitutes a serious but under-recognized public health problem, particularly, in developing countries. Neurocysticercosis, which is the larval stage of T. solium in the central nervous system, is a leading cause of epilepsy in endemic areas. This study was conducted to generate baseline information regarding the seroprevalence and risk factors of human cysticercosis, and its association with epilepsy in Mocuba District in Zambezia Province, Central Mozambique.

Methods: A cross-sectional study was carried out in seven villages of the study district. Sera of 1086 persons were tested for T. solium cysticercosis antibodies by Western Blot IgG kits and for circulating antigens by HP10 Ag-ELISA assay. A questionnaire was used to collect socio-demographic, cysticercosis clinical data, and other related biological and exposure variables at individual and household levels.

Results: The study revealed that 54 (4.9%) persons had T. solium circulating antigens as detected by Ag-ELISA test, while immunoblot test on the same sample found 72 (6.6%) persons seropositive. Among 111(10%) persons reportedly with epilepsy, 3 (2.7%) and 8 (7.2%) were found positive by Ag-ELISA and immunoblot tests, respectively, and did not differ significantly (p > 0.05) from that of non-epileptic persons (51/975, 5.2% and 64/975, 6.6%, by Ag-ELISA and Immunoblot tests, respectively). Old age (OR = 7.76; 95% CI = 2.35 – 25.57), being a male (OR = 2.25; 95% CI: 1.51–3.34), and lack of knowledge on T. solium (OR = 3.91; 95% CI: 1.25–12.25) were significantly associated with seropositivity to T. solium cysticercosis by Ag-ELISA.

Conclusion: Our findings confirm that human T. solium cysticercosis is present in the area and plays an important role as an aetiological cause of epilepsy though it might not be the only cause of epilepsy in the area. Further epidemiological, clinical, and imaging studies are needed to generate more baseline information regarding the burden of disease and its clinical features.


18

24

3. Title: Prevalence of cysticercosis in pork entering the food chain in Rwanda

Authors: Shyaka, A., Rujeni, N., Fèvre, E. and Quinnell, R.

Abstract

There is an increase in pork consumption in Rwanda, with pork entering the food chain via both formal and informal routes. We sampled slaughtered pigs from the formal route by visiting five abattoirs in four of the five provinces in Rwanda. Around 100 pigs were sampled at each abattoir. Serum samples were tested using commercial antigen ELISA. In addition, 77 pigs from two abattoirs were examined by dissecting the whole carcass. Seroprevalence of infection varied from 10 – 40%, and the carcass dissection showed high cyst burdens in many pigs. There was a relatively low concordance between serology and carcass results. These results suggest that measures of improving the safety of pork production in the region ought to be considered.

Morogoro, Tanzania



Munich, Germany






19

25

4. Title: Mapping occurrence of Taenia solium taeniosis/cysticercosis and areas at risk of taeniosis/cysticercosis

Author: Braae, U. C., Devleesschauwer, B., Sithole, F., Wang, Z. and Willingham A. L.

Abstract

Background: This study aimed at mapping the occurrence of Taenia solium taeniosis/cysticercosis at the national level in Central America and the Caribbean basin, and the distribution of porcine cysticercosis at first-level administrative subdivision level (department level), and the porcine population that is at risk. This zoonotic parasite is believed to be widely endemic across most of Latin America. However, there is little information on the occurrence of Taenia solium taeniosis/cysticercosis, distribution of porcine cysticercosis, and the porcine population that is at risk for Central America and the Caribbean basin. Taenia solium has been ranked as the most important foodborne parasitic hazards globally and within endemic areas as a common cause of preventable epilepsy.

Methods: We conducted a structured literature search in PubMed, supplemented with crossed-referenced with relevant academic databases, grey literature, and active searches in identified literature, to identify all records of T. solium presence in Central America and the Caribbean basin between 1986 and April 2017. To retrieve grey literature, government entities, researchers, and relevant institutions across the region were contacted for the purposes of covering all countries and territories. The identified records containing data on porcine cysticercosis were geo-referenced to identify department level distribution and compared to modelled distributions of pigs reared under extensive production systems.

Results: We identified 51 records of T. solium at the national level, covering 13 countries. Additional three countries were included based on World Organisation for Animal Health (OIE) reports, giving 16 countries out of 41 with evidence of the presence of the parasite. Screening records for porcine cysticercosis data at the departmental level confirmed the presence of porcine cysticercosis in 11 departments across six countries (Colombia, Guatemala, Honduras, Mexico, Nicaragua, and Venezuela).

Conclusions: When comparing these results to areas where pigs were kept in extensive production systems and areas where no information on porcine cysticercosis exists, it is apparent that porcine cysticercosis is likely to be underreported, and that a substantial part of the regional pig population could be at risk of contracting porcine cysticercosis. More detailed information on the distribution of T. solium and accurate burden estimations are urgently needed to grasp the true extent of zoonotic parasite and the public health and agricultural problems it potentially poses.


20

26

B1. Diagnostic and Clinical aspects of Cysticercosis/Taeniosis and Case Management

Keynote Prof. Héctor H. Garcia

Presentations:

1. Title: The prevalence of neurocysticercosis among cysticercosis positive individuals and characterization of associated clinical symptoms

Authors: Zulu, G., Mutale, W., Stelzle, D., Mwape, K. E., Sikasunge, C. S., Schmidt, V., Mubanga, C. Phiri, I. K. and Winkler, A. S.

Abstract

Introduction: Taenia solium taeniosis/cysticercosis is a neglected zoonotic parasitic disease complex occurring in many developing countries and cause significant economic and public health impacts. Neurocysticercosis (NCC) is estimated to be responsible for 30% of cases of acquired epilepsy in the endemic areas. An accurate estimate of the prevalence of NCC among people with cysticercosis in Zambia is not well known. A recent pilot study reported the prevalence of NCC among people with epilepsy as over 50%. Data on the full range of clinical characteristics of NCC are essential to estimate accurately the burden of NCC in a community. This would also assist in improving diagnostic ability and alertness among medical staff and provide policymakers with the necessary information for the development of NCC management guidelines. The study aims at raising awareness of the magnitude of the T. solium (neuro) cysticercosis and taeniosis problem in the study areas of Zambia.

Methods: A community-based, cross-sectional study is currently being conducted in Chipata District of the eastern province of Zambia. Blood and stool samples were obtained for serological tests and coproantigen ELISA respectively. In addition, microscopically was examined for the presence of T. solium eggs and for Taenia DNA. The Cysticercosis positive participants would be followed further for neurological examinations and CT scanning.

Results:The preliminary results from 1615 participants have shown 5 percent taeniosis prevalence by microscopy examination of stool and 12.3 percent by coproantigen ELISA. Serology results based on serum antigen showed that 3.1 percent of the participants were positive for cysticercosis.

Conclusion: The findings indicate that taeniosis and cysticercosis are prevalent in the study area. These results would help policymakers understand the magnitude of the problem.


21

27

2. Title: Epidemiology and clinical characteristics of (neuro)cysticercosis patients in Europe Authors: Abraham, A., Stelzle, D., Kaminski, M., Schmidt, V., Carmen, C., Gabriël, S., Bustos, J., Meijere, R., Sahu, P. S., Garcia, H. H. and Winkler, A. S.

Abstract

Background: Human Neurocysticercosis (NCC) caused by the larval stage of the zoonotic tapeworm Taenia solium, is one of the leading causes of secondary epilepsy worldwide. In Europe, NCC is a rare disease and many clinicians are not experienced with the diagnosis and treatment of this disease. This study aimed at describing the occurrence of NCC and clinical characteristics of NCC patients diagnosed and treated in Europe.

Methods: We conducted a systematic literature search of published and unpublished data; unpublished cases and clinical/radiological characteristics were retrieved through personal contacts to clinicians. Furthermore, data from national reporting systems on cysticercosis and reporting systems based on the international classification code (ICD) were summarized. Statistical analyses were carried out using R and EMMa.

Results: Between 2000 and 2016, 3,489 ICD-based cases, ten cases through mandatory notification and 721 aggregated cases were identified. 293 individual NCC cases (210 published, 83 unpublished) were identified through literature search for the years 2000 to 2019. Clinical characteristics: 58% of patients presented with seizures (20% focal onset); 52% presented with severe headache and 58% had focal neurological signs. The majority of patients had a travel or migration history (76%) mostly from/to Latin America (38%), Asia (30%) and Africa (32%). At clinical presentation, most patients had cysts in the degenerative stage particularly those presenting with seizures. Treatment varied largely depending on cyst location and number. Among patients with intraventricular cysts, endoscopic removal of cysts was common; patients with parenchymal cyst mostly were treated with albendazole and/or praziquantel for different durations of time. The outcome was favourable in 90% of the cases. Five patients passed away during or after therapy of which four were younger than 40 years old.

Conclusions: Neurocysticercosis is a rare disease in Europe and no standardized treatment recommendations are in place. With increasing travel and migration to and from areas endemic for T. solium, it’s likely that in the future NCC cases will still be seen in Europe. As treatment and diagnosis of NCC can be challenging, clear guidance and training of clinicians would be an asset for good patient management.


22

28

3. Title: Clinical and imaging features of patients with epilepsy and its association with neurocysticercosis in patients from Mocuba District, Zambézia Province, Mozambique: preliminary results

Authors: Padama, F., Langa, I., Nhacumpe, N., Pondja, A. and Noormahomed, E.V.

Abstract

Background: Neurocysticercosis (NCC) is considered a major cause of epilepsy and other neuropsychiatric disorders in developing countries where Taenia solium is endemic. Its clinical manifestations depend on the number, size, evolutive stage, and location in the central nervous system. We analyzed clinical and imaging features of patients with epilepsy to explore its associations with NCC.

Methodology: We conducted a cross-sectional study between March to June 2019. We recruited 246 patients from Mocuba District, Zambezia Province, presenting with epilepsy, epileptic seizures and positive serology for cysticercosis antigens or antibodies. From all the patients, we registered sociodemographic data such as age, gender, and clinical data such as epilepsy or epileptic seizures and headache. A subset of 229 patients was offered a plain computed tomography (CT-scan) for the detection of any brain lesions consistent or suggestive of NCC.

Results: Amongst the 246 studied patients, 135 (54.9%) were males and 111(45.1%) were females with a mean age of 26 years, and children comprised 83 (33.7%). Concerning serological assays, we found that 45% and 60% were positive for cysticercosis antigens and antibodies respectively. The main symptoms and complaints were epileptic seizures 160 (65.0%), headache 85 (34.6%), and hemiparesis 1 (0.4%). The CT scan examination revealed that 7 (3.0%) patients had vesicular lesions, 21 (9.1%) had multiple calcifications, 6 (2.6%) had brain atrophy, 18 (7.8%) had cortical calcifications, and 1(0.4%) had an ischemic stroke. Calcified lesions were more evident in patients of over 46 years 10 (47.6%) as opposed to children 1 (4.8%).

Conclusion: The study found lesions suggestive of NCC which were associated with epilepsy. More lesions were found in adult patients than in children. Multiple calcifications were the most observed lesions while seizures and headaches were the most common symptoms presented in patients.


23

29

4. Title: Patients with severe manifestation of active neurocysticercosis in southern Tanzania: a case series

Authors: Stelzle, D., Makasi, C., Rüther, C., Zulu, G., Bottieau, E., Schmidt, V., Gabriël, S., Ngowi, B. and Winkler, A. S.

Abstract

Introduction: The SOLID project aims at evaluating a novel point-of-care (POC) test for the diagnosis of T. solium taeniosis and (neuro) cysticercosis (TSTC) in endemic areas.

Methods: In Tanzania, this study was conducted in three district hospitals (Ifisi, Tukuyu, and Vwawa) in Mbeya region. Every patient attending the mental health clinic in one of the three hospitals was tested with the novel POC-test. Here we present two patients from Vwawa hospital with severe manifestation of active neurocysticercosis.

Results: Patient 1: a 30-year old man who presented with intermittent loss of memory to the OPD. The POC test was positive for cysticercosis. Past medical history yielded one episode of loss of consciousness and subsequent fall at the age of 14. The patient suffers from headache episodes around once a month; the headache (bilateral, throbbing pain located on the front of the head) gets progressively worse to an intensity of 3/5 and is accompanied with photophobia and nausea, which usually lasts for several hours. Neurological examination was normal. CT findings: Overall, the patient had 50 parenchymal and subarachnoidal cysts; one of which was in the cerebella peduncle near the brainstem. No ring enhancement, perilesional oedema, hydrocephalus, atrophy or other pathologies were seen.

Patient 2: a 28-year old mother who attended the mental health clinic because of known epilepsy. The POC test was positive for cysticercosis. The patient is breastfeeding. She takes regular anti-epileptic medication (PB 100mg/d and CBZ 400mg/d) and although her seizures decreased, she still suffers 1–2 seizures per month. The patient furthermore reports daily short headache episodes (intensity 4/5) located bilaterally on the vertex. Neurological examination was normal. CT findings: Overall, the patient has more than 80 parenchymal, subarachnoidal and intraventricular cysts – one of them in the granular nodular stage. No hydrocephalus, no atrophy, or other pathologies were seen.

Conclusion: In both patients, anthelminthic medication was contraindicated because of the large number of cysts, and a cyst near the brainstem (patient 1). In that scenario, patients can only be treated symptomatically, in other words, adjusting anti-epileptic medication, and offering analgesics, and on a case-by-case basis, administering steroids temporarily observing obvious contraindications.


24

30

B2. Diagnostic and Clinical Aspects of Cysticercosis/Taeniosis and Case Management

Keynote Prof. Sarah Gabriël

Presentations:

1. Title: Accurate and sensitive assessment of porcine cysticercosis at post-mortem

Author: Lightowlers, M.

Abstract

At present, the only method available for accurate and sensitivity diagnosis of porcine cysticercosis is identification of cysts following laborious hand slicing and inspection of the meat.

We investigated lesions, which were found in tissue locations other than the striated musculature or brain in pigs reared in Taenia solium-endemic areas of Uganda and Nepal. Lesions from the lungs, liver, spleen, and kidney were examined macroscopically and microscopically by histology and by DNA analyses. Some lesions were identified as having been caused by nematode infections, Taenia hydatigena, Taenia asiatica (in Nepal), or Echinococcus granulosus. The aetiology of other lesions was unable to be identified, for example, fibrotic or inflammatory lesions had no clear cause or calcified lesions. However, no lesion, other than those from striated muscle or brain, was confirmed as T. solium. Our data on the tissue distribution of T. solium cysticerci in naturally infected pigs is consistent with the findings of almost all previous studies on the topic. For these reasons, we suggest that post-mortem assessment of porcine cysticercosis does not require examination (i.e. slicing) of organs such as the liver, lungs, spleen, or kidneys.

As post-mortem assessment, which is porcine cysticercosis, is often primarily concerned with determining whether an animal is infected per se, rather than an accurate determination of the exact burden of the infection. In our studies in Nepal and Uganda, every animal found to have cysts in the brain also had cysts in the striated muscle. This is consistent with every relevant published study. To our knowledge, there is only a single animal, which was found to have cysts (a single cyst) in the brain but no cysts in the musculature. This is out of hundreds of animals that have undergone total post-mortem analysis. As extraction of the brain of the pig for analysis is time consuming, we propose that it is not necessary to examine the brain in order to get a sufficiently accurate diagnosis of porcine cysticercosis. Excluding the brain would reduce further the efforts of undertaking post-mortem assessment of porcine cysticercosis.


25

31

2. Title: Application of droplet digital Polymerase Chain Reaction for the detection and absolute quantification of Taenia solium eggs in soil

Authors: Maganira, J., Mwang'ondea, B., Kidimab, W., Mwita, C. and Höglundd, J.

Abstract

To enable the detection of taeniid eggs in environmental samples, a sensitive technology is required. In this study, we validated the effectiveness of a digital droplet Polymerase Chain Reaction (ddPCR) assay for the detection, identification, and absolute quantification of taeniid DNA from contaminated soils (sand, silt, loam, and clay) with varying numbers of taeniid eggs using a set of universal primers, JB3 and JB4.5. DNA was extracted from 5 g of each soil type spiked in triplicates with approximately 10, 50, 100, and 500 Taenia solium (pork tapeworm) or Taenia lynciscapreoli (lynx tapeworm) eggs and then analyzed in technical duplicates using the ddPCR technology.

In this study, the ddPCR detection range for cytochrome c oxidase I (cox1) gene was from 7,180 to 67,000 copies per reaction mixture for DNA from T. solium cysticerci or T. lynciscapreoli tissue and from 10 to 14,000 copies per reaction mixture for DNA recovered in the spiked soils with eggs of both tapeworms. The results showed that the number of cox1 copies increased gradually for both species with the number of taeniid eggs added to the different soil types.

For both, T. solium and T. lynciscapreoli species, the highest cox1 DNA copies recovery was from the sand soil, while clay indicated the lowest recovery. In general, the number of cox1 DNA copies was greater in soils spiked with T. solium eggs (64%) than in soils with T. lynciscapreoli eggs (36%). Based on our results, ddPCR seems to be a promising technology for screening taeniid eggs in soil samples collected in the environment irrespective of the soil type and the number of eggs. However, the results of this study also indicate that soil type is an important variable, which needs to be considered since there were statistically significant differences in the mean cox1 copies between soil types spiked with varying egg concentrations for both taeniid species. The ddPCR protocol potential of detecting taeniid egg DNA in spiked soil samples has great practical application for taeniid egg screening in soils from endemic areas. However, further validation using species-specific primers and field soil samples is equally important.


26

32

3. Title: Patients' perceptions on the acceptability of a prototype point of care test for human taeniosis and cysticercosis diagnosis in Mbeya and Songwe regions, Tanzania

Authors: Thomas, E., Nonga, H. E., Ngowi, B., Johansen, M. V., Gabriel, S., Ngowi, H. and Magnussen, P.

Abstract

The proto-type Taenia solium taeniosis/cysticercosis point of care (TSTC-POC) test is a combined T. solium taeniosis /cysticercosis diagnostic test that enables immediate diagnosis of individuals suffering from taeniosis, cysticercosis or both, and hence, enabling immediate interventions. A cross-sectional study was carried out in selected district health facilities (Ifisi, Makandana, and Vwawa) of Mbeya and Songwe Regions southern, Tanzania to assess the perceptions and factors influencing the acceptability of the TSTC-POC test among individuals who were tested during a TSTC-POC proto-type evaluation. The assessment of acceptability of the TSTC-POC test was carried out through the application of Health Belief Model (HBM), a social science theoretical framework.

Two hundred and sixty (260) persons were interviewed using a structured questionnaire immediately after undertaking the TSTC-POC test. Data were analyzed using SPSS 16.0 where descriptive statistics (frequencies and percentages) and the association between variables using Chi-square test were computed. Statistical significance was established at 95 percent confidence level and p-value <0.05. The acceptability of the POC test was high (95.4%). The main factor making the test acceptable was the short time it takes between testing and getting the result (45.3% of the respondents). The factors that motivated individuals to undergo the TSTC-POC test include the perceived threat of disease (death and disabilities), trust in health practitioners, and the diagnostic tool itself.

It is concluded that the TSTC-POC test is acceptable among the study population of Mbeya and Songwe regions, southern Tanzania. Acceptability of TSTC-POC test was not influenced by the study hospital, age groups, gender, education level, and primary occupation of the study participants. Information on the test's efficacy and effectiveness is required to guide its adoption and promotion for control of TSTC in Tanzania, a potential breakthrough in TSTC surveillance.


27

33

4. Title: Evaluation of the accuracy of serologic tests in the diagnosis of neurocysticercosis with CT scan as gold standard in Mocuba District, Zambezia-Mozambique

Authors: Banze , L., Langa, I., Padama, F. and Noormahomed, E. V.

Abstract

Introduction: The diagnosis of cysticercosis and neurocysticercosis (NCC) is currently based on laboratory tests. The high sensitivity of the ELISA test, coupled with the high specificity of immunoblot, (WB) allows an efficient joint use of the two tests in research. However, when evaluated with serum samples, the sensitivity and specificity of this test depend on the antigen and the type of assay used, the course of infection, and the origin of the patient.

Methods: A cross-sectional study was conducted in the Mocuba District between March and August 2018, whereby patients aged two years and older with reported epileptic seizures were recruited. Epidemiological, demographic, and clinical data were obtained using a questionnaire. Blood samples were collected and tested for T. solium cysticercosis by Ag-ELISA and WB techniques.

Results: We included 64 patients with a mean age of 30 years, 53% were females, and 14% were children aged 10 to 14 years. The Ag-ELISA and WB serological tests were positive in 40.6% (26/64) and 21.9% (14/64) respectively. About 64.1% (41/64) of the patients had a positive result on CT scan, all of them 100% (41/41) showed calcification stage, and 12.2% (5/41) showed cysts with a scolex. There was an agreement with the literature on the sensitivity and specificity values of the two tests, since we had the results of the CT scan 100% (41/41) calcified, knowing the sensitivity in patients with unique lesions due to insufficient immune stimulation drops from 60 to 80%. The predictive values calculated in the two tests are close to the limits of the established intervals. The predictive values of Ag-ELISA tend towards the upper limit, which reveals an adequate sensitivity and specificity. On the other hand, WB has only a positive predictive value that tends towards the upper limit, which reveals an optimal specificity, because, the higher the specificity, the less the possibility that an individual with a positive test is not ill. Therefore, the positive predictive value will be greater.


28

34

Day 2, Wednesday 27th November 2019

C. Basic and Immunological Aspects of Cysticercosis/Taeniosis

Keynote Prof. Agnès Fleury

Presentations:

1. Title: The immune system response in HIV patients with Taenia solium neurocysticercosis from Southern Highlands, Tanzania

Authors: Lema, Y., Prodjinotho, F.U., Lyamuya, E., Carabin, H., Winkler, A.S., Chachage, M., Ngowi, B. and Prazeres da Costa, C.

Abstract

Taenia solium cysticercosis is an emerging but neglected parasitic and zoonotic disease. In Sub- Saharan Africa, neurocysticercosis is the leading cause of acquired epilepsy, which is reported in 80% of the symptomatic cases. It is estimated that between 10 and 20% of the people living with HIV AIDS may suffer from cysticercosis; however, this has only been investigated patchily.

Current diagnostic tests include neuroimaging and immuno-diagnostic test. Clinical presentation of neurocysticercosis depends on factors such as cyst stage, number of cysts, and their location in the brain. These factors also influence the nature and type of immune response observed. Little is known on the role HIV plays in modifying the immune response and subsequent modification of the disease presentation that, in turn, affects the clinical management of the disease case. This warrants new research into the complex interaction between NCC, HIV, and the host immune response.

The current study aims at evaluating the peripheral immune response associated with T. solium neurocysticercosis in HIV patients by comparing the specific immune response between HIV patients co-infected with neurocysticercosis and control groups of patients that are HIV negative. The study will also determine the changes in immune response associated with the initiation of anti-retroviral and anti-helminthic treatment.

This study is part of a large case control project that will recruit patients at HIV clinics, in the surrounding communities in Iringa and Mbeya regions. Control subjects are HIV negative, matched by age and gender. All participants will be screened for neurocysticercosis using both antigen and antibody ELISA. Positive patients will receive a brain CT scan, immune phenotypes, related cytokines. Changes in cytokine concentration following treatment will be determined using Luminex xMAP multiplex. Participants will be followed up for one year post treatment. Significant change in cytokine levels will be established in the analysis using paired t-test. The study duration is four years. The findings will aid in case management of HIV and neurocysticercosis co-infected patients.


29

35

2. Title: Taenia solium neurocysticercosis infection: understanding the immune regulation and pathogenesis from in vitro investigation

Authors: Prodjinotho, F.U., Schmidt, V., Sikasunge, C., Winkler, A. S. and Prazeres da Costa, C.

Abstract

Introduction: Neurocysticercosis, the larval stage of the pork tapeworm Taenia solium in the human central nervous system is a food-borne neglected tropical disease and the most common cause of epilepsy in endemic regions such as Sub-Sahara Africa. The immune response in affected individuals and associated clinical presentations are very diverse involving complex type 1/2 immune responses and strongly depends on the stage of a larval cyst, which alters innate and adaptive immune cell reactivity to prevent potentially harmful responses in the brain. However, up to now, macrophage, dendritic, and T cells responses to different cyst components are not yet fully known.

Objective: The present work aims at investigating the effects of Taenia solium cyst-related products on innate (macrophage and dendritic cells) and adaptive (T cells) responses in order to establish an antigen-specific immune response method.

Materials and Methods: Taenia solium cyst antigen lysate was prepared from cysts collected from an infected pig and cultured with peripheral blood mononuclear cells (PBMC) from healthy German volunteers as well as murine bone-marrow derived dendritic cells (BMDDC). The effect of the cyst antigen lysate was investigated by a flow cytometry analysis of the subsets (Th1/Th2/Th17/Treg) and TNFα, IL-6, TGF-ß and IL-10 cytokine secretion. The underlying mechanistic aspects were explored using neutralizing antibodies and IL-10R deficient mice.

Results and conclusion: The prepared cyst antigen lysate induced significant levels of IL-10 in BMDDC. This is associated with the induction of peripheral Tregs (CD4+CD25highFoxP3+). Interestingly, IL-10R deficiency did not completely impair Treg induction. However, the cyst materials were not prominent Th1 and Th2 inducers as revealed by the determination of the expression of TNFα, IFNγ, IL-5, Tbet and GATA-3. Our findings suggest that, although healthy donors do not react to the cyst antigen lysate for Th1/Th2 cytokine production as expected, the lysate promotes an anti-inflammatory response via the induction of Tregs, which in turn, may favour a suppressive environment for parasite establishment. The current work focuses on the identification of active molecules and the underlying mechanism pathways for Treg induction.


30

36

3. Title: Sero-epidemiology of human and porcine cysticercosis in Rwanda: a countrywide survey

Authors: Rujeni, N., Shyaka, A., Fèvre, E. and Quinnell, R.

Abstract

Pig production is increasing in Rwanda; however, there have been no detailed surveys on the prevalence of cysticercosis. Here, we present the results of a cross-sectional survey of 10 rural communities across the country. Communities were selected at random from districts with high pig population in 4 of the 5 provinces. Human (n=1000) and porcine (n=580) serum samples were collected and tested by commercial antigen ELISA, and detail data on potential risk factors were collected using questionnaires. The overall human prevalence was c. 6 percent, varying from 1 – 20 percent across communities. Porcine prevalence was higher, 13 percent, and varied from 3 – 49 percent. These results show that there is a very high prevalence of cysticercosis, which is associated with smallholder pig production in some communities in Southern Province. Individual and community risk factors for infection are discussed.


31

37

4. Title: TSOL18 vaccine and oxfendazole for control of Taenia solium cysticercosis in pigs: A field trial in rural areas of Tanzania

Authors: Kabululu, M.L., Ngowi, H.A., Mlangwa, J.E.D., Mkupasi, E.M., Braae, U.C., Colston, A., Cordel, C., Poole, E.J. and Johansen, M.J.

Abstract

A low-intervention trial was conducted in Mbeya Rural and Mbozi Districts in Tanzania, to determine the effectiveness of TSOL18 used in combination with oxfendazole and of oxfendazole alone, on T. solium cysticercosis, which is determined by carcass dissection of slaughter age pigs. We conducted a parallel-group study where sites were randomly allocated to either treatment group T1 (oxfendazole treatment alone [30 mg/kg, Paranthic™10%]), or treatment group T2 (TSOL18 [1ml, Cysvax™] plus oxfendazole). Three rounds of treatment at four-month intervals were completed. The post-intervention pig necropsies were conducted 11 months after the first treatment round. Additionally, pigs from T1 and T2 areas, that had not received treatment, were sacrificed to serve as post-intervention controls (T3).

At baseline, 47 and 100 pigs from T1 and T2 areas respectively were slaughtered. After the intervention, 36 pigs in T1, and 77 pigs in T2 were slaughtered; and additional 8 from T1 area and 35 from T2 area were slaughtered to serve as controls (T3). Twelve pigs from T1 were infected at baseline (25.5%, 95% CI: 13.9, 40.3); and 12 pigs (12%) from T2 were infected (95% CI: 6.4, 20). After the intervention, one pig from T1 was infected (2.8%, 95% CI: 0.1, 14.5) while no pig from T2 was infected (0%, 95% CI: 0.1, 14.5). Among controls after the intervention, one pig (12.5%) from T1 was infected (95% CI: 0.3, 52.7) and two pigs (5.7%) from T2 were infected (95% CI: 0.7, 19.2). Firth’s Penalized Maximum Likelihood estimation method showed that the prevalence values averaged across T1 and T2 and their controls were significantly lower after the intervention than at the baseline (p=0.011 for T1 and p=0.007 for T2). However, there were no significant effects of the interventions (P =0245 for T1 and P=0.076 for T2) when taking into account their controls and baseline values. These findings suggest that either treatment strategy is capable of bringing the prevalence below a threshold, which is likely to be appropriate for long-term control in endemic areas. However, long-term effects of the treatment strategies and potential spill-over into the human and non-treated porcine populations needs to be explored


32

38

5. Title: Field trial to evaluate the safety and efficacy of cysvax™ recombinant porcine cysticercosis vaccine in pigs kept under field conditions in Tanzania

Authors: Makundi, A., Colston, A., Cordel, C., Lingala, R., Kumar, M., Periasamy, S., Poole, J. and Salt, J.

Abstract

Background: A trial was conducted in Hanang and Babati Districts in Tanzania, to evaluate the safety and efficacy of Cysvax™ recombinant DNA vaccine administered to pigs under field conditions and exposed to natural infection with T. solium. One hundred pigs from three villages in Babati District and two villages in Hanang District were randomly selected and ear-tagged with unique identification numbers. Sixty-seven pigs were vaccinated with two doses of Cysvax vaccine three weeks apart, and 33 pigs were administered with saline, both by intramuscular injection. Clinical observations, rectal temperature, body weight, and local injection site assessments were performed to all pigs until two weeks after the second vaccination. Blood samples were taken and analyzed for TSOL 18 antibodies by cELISA.

Results: About 95 animals completed the study, but five animals died due to road accidents and predators. Although the average bodyweight of the Cysvax™ treated animals increased from 29.6 to 31.1 kgs, compared to the control animals which increased slightly from 26.9 to 27.1 kgs, the increase was not statistically significantly different (p=0.063). No severe injection site reactions in any studied animals were observed. Mild clinical signs were observed in five and seven in the Controls treated Groups respectively. The average rectal temperatures in both groups did not exceed the maximum normal rectal temperature range for pigs. However, the Cysvax group exhibited a statistically significant (p=0.002) transient elevation in temperature four hours after the second vaccination. Sixty-two out of sixty-three (98.4%) vaccinated animals raised detectable antibody titres (mean TSOL18 log2 titres were 13.37 ± 1.50) to TSOL18 that were significantly different (p<0.001) compared to the control group (mean TSOL18 log2 titres were 10.44 ± 1.88).

Conclusion: Cysvax™ vaccine is safe for use in pigs in the prevailing pig-farming systems in Tanzania. No animals became ill or died as a result of vaccine use. Almost all pigs vaccinated with Cysvax™ vaccine (98.4%) raised detectable antibody titres against TSOL18, such that a significant serological benefit from vaccination can be achieved


33

39

D. Control and Prevention of Taeniosis/Cysticercosis

Keynote Prof. Arve Lee Willingham

Presentations:

1. Title: Taenia solium taeniosis and cysticercosis burden and potential for control in Tanzania: Twenty-three years research synthesis

Authors: Ngowi, H., Winkler, A.S., Braae, U.C., Mdegela, R., Mkupasi,E.M., Kabululu, M., Lekule, F. and Johansen, M.V.

Abstract

Background: Over the last few years Taenia solium taeniosis/cysticercosis (TSTC) has been put high on the global agenda of neglected tropical diseases (NTDs) requiring attention towards research, control and ultimately eradication. Nevertheless, global efforts are hindered by a lack of control programmes in endemic countries, presumably due to lack of country level information on TSTC burden and impact. We have mapped out TSTC research evidence in Tanzania to inform on disease burden and potential for control.

Methodology/Principal findings: A scoping review of all (n = 51) TSTC studies undertaken in Tanzania and published up to December 2018 was conducted. Prevalence of taeniosis was 2.3% - 5.2% based on copro-antigen ELISA while human cysticercosis was >16% based on antigen ELISA (Ag-ELISA) or IgG Western Blot. Neurocysticercosis (NCC) contributed significantly to epilepsy in adults. Farm prevalence of porcine cysticercosis were 6.0% - 17.4% (lingual examination) and 1.5% - 33.3% (Ag-ELISA). Slaughter-slab prevalence were 0% - 18.2% (standard meat inspection). Lacking latrines, watering pigs with river or pond water, and feeding pigs with potato peels were associated with porcine cysticercosis. Washing hands by dipping method increased the risk of human cysticercosis. In 2012, around 5 million USD (95% UI, 797,535–16,933,477) were spent due to NCC-associated epilepsy and nearly 3 million USD (95% UI, 1,095,960–5,366,038) were potentially lost due to porcine cysticercosis. Three rounds of annual treatment of school-age children with praziquantel significantly reduced the prevalence of taeniosis and porcine cysticercosis. Health education was efficacious in improving knowledge and attitudes favourable for control of TSTC while a single dose of oxfendazole 30 mg/kg body weight eliminated cysticerci from pig musculature.

Conclusions/Significance: The observed high burden of TSTC and the significant contribution of NCC to epilepsy in Tanzania warrant urgent interventions. Evaluation of best control options should make use of disease transmission dynamics models such as cystiSim, taking into account findings from the field based intervention studies. In addition, locally adapted management guidelines for people suffering from NCC are urgently needed.


34

40

2. Title: Control of porcine cysticercosis and taeniosis: A qualitative assessment of possible control strategies using a theory of change approach

Authors: Ngwili, N., Thomas, L., Wahome, R., Githigia, S., Johnson, N. and Roesel, K.

Abstract

Despite international declarations of accelerating control programmes and the availability of a ‘toolkit’ of control options, Taenia solium remains endemic in many regions. It has been suggested that within endemic countries, stakeholders should be engaged to develop country-specific control goals and locally acceptable control programmes with standardised monitoring protocols. We propose that this process may be facilitated through the use of a ‘Theory of Change’ (ToC) framework with stakeholders within an endemic community.

The ToC approach describes how a programme brings about specific long-term outcomes through a logical sequence of intermediate outcomes. This approach will be used to assess qualitatively how different interventions are expected to work in Kamuli and Hoima Districts of Uganda. The initial step of this process is the understanding of how interventions in other endemic regions have been successfully planned, implemented, and evaluated. The information to be gathered through an ongoing systematic literature review, supplemented by interviews with authors, would form a framework of a draft impact pathway under different intervention scenarios.

The draft impact pathway would be used to guide focus group discussions with key stakeholders from pig production, human, and animal health locally in the study sites, regionally, and internationally. Stakeholders will be facilitated to define and discuss risks, uncertainties, and assumptions underlying each of the proposed control options. Stakeholders will be probed on their perceptions of those factors that may contribute to success of the intervention. They will also be asked to identify those who will be responsible for planning and implementation of each control scenario.

Through this work, we will produce, for the first time, a qualitatively narrated ToC framework identifying potential successful control interventions in a T. solium endemic area, with an accompanying roadmap of the enabling environment required to facilitate these interventions. This will provide a framework for other endemic areas to develop their own stepwise approaches of controlling this important, yet neglected, zoonotic parasite.

The project is funded by the CGIAR Research Program on Agriculture for Nutrition and Health (A4NH) and is part of a PhD research under the ILRI/DAAD scholarship programme.


35

41

3. Title: Open defecation free status alone, not enough for the control of porcine cysticercosis

Authors: Mwape, K. E., Sikasunge, C., Chota, A., Phiri, I., Chembensofu, M., Dorny P. and Gabriël, S.

Abstract

Introduction: Taenia solium is an important cause of epilepsy that requires urgent control in endemic areas. Possible control measures include the improvement of basic sanitation, hygiene, and health education. Community-Led Total Sanitation (CLTS) is an innovative community-based sanitation programme aimed at eliminating open defecation in rural communities through the construction of pit latrines. The success of CLTS would be assumed to lead to the control of poor sanitation-related diseases, including human/porcine cysticercosis. In 2007, the CLTS approach in Choma District of the Southern Province, had initial coverage of 40 percent; but, within two months, sanitation coverage increased to 88 percent to a population of 4,536, and 75 percent of the villages were verified as open defecation free (ODF) and soon after this increased to 100percent. One would assume that with ODF status for over 5 years, porcine cysticercosis would have largely been controlled. This study aimed at investigating the prevalence of porcine cysticercosis in the villages declared as ODF in Choma District.

Materials and Methods: The study was conducted in Choma District in the villages declared as ODF 8 years before. Pig keeping households were identified and randomly selected and had their blood collected. A questionnaire was administered to pig keepers to evaluate the level of knowledge of T. solium infections. The B158/B68 antigen ELISA was used to test for porcine cysticercosis in the collected blood. All data were entered in the excel sheet and transferred to SPSS for analysis.

Results/Discussion: The prevalence of 10.9 percent (29/265) of porcine cysticercosis was determined. A study conducted in 2008 reported a prevalence of 34 and 23 percent in two neighbouring districts. Fifty-two questionnaires were administered with only 15 percent reporting having heard of tapeworm infection, 31 percent had observed cysts in pork with 15 percent knowing what the cysts were. None of the respondents knew how pigs acquired the cysts. These results clearly indicate that despite declaring the area as ODF, this status did not lead to a complete control of porcine cysticercosis. This trend, therefore, indicates that improved sanitation alone may not be adequate in the control of porcine cysticercosis but rather an integrated approach utilizing several control tools including health education may be required.


36

42

4. Title: A strategic approach to combining pig and human interventions for control of Taenia solium

Author: Donadeu, M.

Abstract

Effective measures are available for preventing the transmission of Taenia solium. We have highly effective taeniacides, a vaccine, and medication for porcine cysticercosis and opportunities for changes in sanitation and pig rearing practices. These measures are however not being implemented successfully in most regions of the world where the parasite is endemic. Both the on-going effectiveness and sustainability of control measures are critical factors in developing a control program that would be effective as well as practical and cost-effective to implement.

We have undertaken modelling simulations using cystiSim of a variety of control scenarios. The most effective and efficient method of control was found to be a combination of vaccination and oxfendazole medication of pigs together with strategic mass drug administration of an effective taeniacide after the transmission through pigs had already been interrupted.

We have been considering further measures of simplifying this combination of measures. Recent evidence of the prevalence of T. solium infection in naturally infected pigs of different age classes in Nepal has found that few if any animals become infected when they are older than 10-12 months of age animals. Hence, we hypothesise that be effective for the animals’ lifetime, vaccination of pigs may only need to be implemented in relatively young pigs.


37

43

E1. Policy Generation, Implementation, and other Cross-cutting Issues

Keynote Prof. Japhet Killewo

Presentations:

1. Title: Community practices related to epidemiology of Taenia solium in Iringa Rural District, Tanzania

Authors: Kajuna, F.F., Mwang’onde, B.J., Holst, C., Ngowi, B., Winkler, A.S., Ngowi, H.A. and Noll, J.

Abstract

Background: The immanent sociocultural settings and lifestyles of communities in Taenia solium endemic areas form the main concern on the epidemiology of Taenia solium taeniosis-cysticercosis (TSTC). The transmission of TSTC is favoured by poor sanitation and in hygiene motivated by lifestyles, ignorance, and poverty. Health education through mobile phones and the internet might form a key strategy for the prevention and control. Before any strategy, implementation thorough studies are important in breaking the cycles of poverty-related diseases such as TSTC. The potential causes for the persistence of TSTC in Iringa Rural District of Tanzania are presented to guide an interactive facility (free internet kiosk) for public education to break the Taenia solium life cycle. The study intended to explore factors for endemic Taenia solium in the region for responding appropriately.

Methods: This study was cross-sectional; pig-keeping households were identified, and household’s heads were interviewed based on pig raising and management. Health officers and other government officials were key informants on pig rearing systems, sanitation and hygiene, slaughtering, preparation of meat, meat-eating behaviour, and on the epidemiology knowledge concerning TSTC. Direct observations were conducted to supplement information collected through interviews. Data were analyzed descriptively using Microsoft Excel.

Results: Eighty-six (86) out of 88 (97.7%) small-scale pig farmers were surveyed in Izazi, Migoli, and Mlowa wards of Iringa Rural District. Farmers keep pigs for subsistence income. Over 83 percent of farmers were practicing semi-intensive pig rearing and only 2 percent keep pigs under the free-range system. Farmers were well informed on pig housing (82%), though only few (16%) defined pig houses. They (99%) owned latrines although everyday use of these latrines is unknown. farmers need TSTC epidemiology knowledge to discourage persistent pigs roaming, open door latrines, practising open defecation, unsanitary/lack of washing facilities after using the latrine, selling raw or eating pork prepared in poor hygiene/insanitary environment and encourage community slaughter slab and pigs/pork inspection at slaughtering.

Conclusion: Regular training on TSTC epidemiology and proper pig management for health and economic returns is important, and can be provided to all including schoolchildren and the youth for sustainability. Mobile and smartphones with internet connectivity encourage stakeholder’s interaction on health education.


38

44

2. Title: Pig cysticercosis and risk perception among pork consumers in Dar es Salaam

Authors: Minga, G., Kalabi, D. and Magwisha, H.

Abstract

Background: Pig Cysticercosis is a big challenge in East African countries especially Tanzania, with a prevalence of 20 percent, resulting into public health threats. Pork meat is highly consumed in Tanzania. Consumers can become infected with the tapeworms by eating raw or undercooked pork (T. solium and T. asiatica). The risk perception among consumers is not known in Dar es Salaam. This study aims at assessing pig cysticercosis and risk perception among pork consumers in Dar es Salaam.

Methods: A cross-sectional survey was conducted at four municipalities slaughter houses and pork consumers in Dar es Salaam region between March and September 2018. A stratified random sampling method was used to obtain participants. Structured questionnaires and checklists were used to collect information on various parameters. Data were analyzed using SPSS version 22.

Results: A total of 220 participants were enrolled. Pig cysticercosis was observed in 15 percent of all 320 pigs slaughtered, knowledge level was low although the majority had at least a primary level of education, 56.5 percent of the respondents were not frequently de-wormed after every three months although they consumed pork every week. The study also revealed that 55.9 percent had low-risk perception regarding pig cysticercosis. The study observed a significant association between cysticercosis risk perception and the de-worming programme, vis-a-vis other factors, through Chi-square at P<0.05, 95%CI and Logistic regressions OR was 4.195.

Conclusion: This study indicated high needs of sensitization on behaviour intervention due to low disease risk perception, knowledge should be promoted through routine training, deworming programme should be continued.


39

45

3. Title: Knowledge and practices related to human Taenia solium infections in Kongwa District, Dodoma region, Tanzania

Authors: Makingi, G., Mkupasi, E., Ngowi, B., Nzalawahe, J. and Ngowi, H.

Abstract Background: Understanding community’s knowledge and practices towards T. solium taeniosis/ cysticercosis (TSTC) is a key for a successful control strategy. This study is part of a large village-level randomized controlled trial of determining the effects of a locally adapted health education intervention in improving knowledge and practices and reducing the incidence of human cysticercosis in Kongwa and Songwe Districts.

Objective: To assess baseline knowledge and practices related to human TSTC in Kongwa and Songwe Districts.

Methods: This cross-sectional study was conducted from June to September 2019. It included 42 villages, 28(out of 87) from Kongwa; and 14(out of 43) from Songwe. These were selected based on probability proportional to pig population size. A structured questionnaire was administered to 873 households (279 Songwe, 593 Kongwa). In the surveyed village, around 20 households’ representatives were selected by a simple random sampling method for interviews. All data were collected by KoBoToolBox software and analyzed for descriptive statistics and inferential statistics using excel sheet and chi-square.

Results: Approximately 366(61.76%) of the respondents from Kongwa and 221(79.21%) from Songwe were males. A substantial number of the respondents 654(75%) from both districts were adults of the age between 25-55 years. A significant number of the respondents 624(71.6%) had a primary level of education. The findings of this study indicated that 121(20.4%) of the respondents from Kongwa and 29(10.4%) from Songwe had heard about human TSTC. About 177(29.8%) of the respondents from Kongwa and 178(63.8%) from Songwe had seen cysticercosis infected pork. About 165 (27.8%) of the respondents in Kongwa and 177(63.4%) from Songwe agreed with the idea of conducting a free-range pig rearing system. The majority of the respondents 563(95%) from Kongwa were using toilets as opposed to 139(50%) from Songwe. The study revealed that 404(68.1%) of the households from Kongwa were supplied with tap water compared to 46(16.5%) from Songwe.

Conclusion: Substantial number of respondents had no knowledge of TSTC and had practices that favour life cycle of T. solium. Therefore, improvement of public health services and community-based health education on TSTC and its control is needed in the study area.


40

46

4. Title: Knowledge and practices on porcine cysticercosis among smallholder pig farmers in Kongwa district, Tanzania

Authors: Wilson, C., Nonga, H., Mdegela, R., Mkupasi, E. and Ngowi, H.

Abstract Porcine Cysticercosis is one of the neglected zoonotic diseases known to pose serious economic losses and public health impact in developing countries, especially in rural communities. Understanding farmers’ knowledge and practices related to Taenia solium cysticercosis transmission and prevention is a key for successful eradication strategy. A field questionnaire survey was administered to 450 respondents living in 450 households from 28 villages selected randomly in Kongwa District, Dodoma region, central Tanzania to assess knowledge and practices related to porcine cysticercosis caused by T. solium. Quantitative data were analyzed for descriptive and inferential statistics using the Statistical Package for Social Sciences (SPSS 20).

Approximately, 73 percent of the respondents were aware of porcine cysticercosis. Despite that, a significant portion of the respondents knew about T. solium porcine cysticercosis in their area, 46.4 percent did not know how pigs acquire T. solium cysticercosis. In addition, about 2.8 percent of the surveyed households had no latrines while 65 percent of the households had latrines but did not have water and soap, hence, could wash hands after using the latrines. About 12 percent of the study households practiced free-range or semi-intensive pig rearing system, which would allow pigs to access human faeces that might be found in open environments. Furthermore, 18 percent of the surveyed pig farmers admitted having been slaughtering their pigs at home where meat inspection is rarely done. The survey also showed that open defecation and drinking untreated water (e.g. through boiling) were common practices, enhanced by lack of knowledge regarding the transmission of the parasite. Based on these findings, it is recommended that more health education to farmers and a community as a whole regarding T. solium infections is needed in Kongwa District. In addition, epidemiological studies are needed to estimate the prevalence of porcine cysticercosis and associated risk factors in the area.


41

47

5. Title: Influence of Human and Environmental Factors in the Transmission of Taenia Solium Cysticercosis in Villages of Alfred Nzo and or Tambo Districts of the Eastern Cape Province, South Africa

Authors: Sithole, M.I., Bekker, J. L. and Mukaratirwa, S.

Abstract Taenia solium is an emerging and expanding zoonosis in Africa leading to human cysticercosis. Within the sub-Saharan region, South Africa has the highest reported prevalence of cysticercosis as a result of its large number of pigs. A large proportion of farming is done by resource-poor farmers in the Eastern Cape Province. These pigs are mostly of indigenous breed and kept as free ranging. Information regarding the study was obtained through the analysis of meat inspection and Ag-ELISA against dissection (N=180) carcasses as the “gold standard” to determine the prevalence and the spread of cysts in the carcasses, questionnaire responses from rural pig owners (N=180) on the pig keeping/husbandry and consumers (N=361) on knowledge and food safety practices followed. The pig keeping practices were not always supporting the control of pig cysticercosis. Pigs were often free range and were exposed to human and animal (especially) dog faeces. Although sanitation was available in most of the villages, these were not always used due to certain practical reasons. Furthermore, it was evident that cysts were not only limited to the conventional areas checked during primary meat inspection but that they could be found in areas which are of economic importance and would preferably not be cut during inspection. The results showed that areas of pig keeping need to be improved on and that the pig owners need to be educated about the possible risks of the disease. Furthermore, it was evident that, in addition to normal primary meat inspection, additional measures might be required to prevent the transmission of this zoonotic disease to consumers of pork.


42

48

6. Title: Adoption, users experience, and effectiveness of The Government of Tanzania-Hospital Management Information System in a primary healthcare facility in Tanzania

Authors: Lengai, E. and Sukums, F.

Abstract

Background: Electronic medical records (EMR) have transformed the collection, storage, retrieval, and use of medical information. This has led to hospitals increasing investments in EMR adoption and implementation in both developed and developing countries. However, the EMR implementation is a complex endeavour and thus calling for the necessity of assessing the successes of such investments at the various stages of implementation. The main objective of this study was to assess the adoption, users’ experience, and effectiveness of the Government of Tanzania-Hospital Management Information System (GoT-HoMIS) on improving health care delivery in Meru District Hospital.

Methodology: A cross-sectional descriptive study employing a qualitative approach was conducted in Meru District Hospital between May and June 2019. The study involved purposive quota selection of hospital managers and healthcare providers including clinicians, medical recorders, cashiers, pharmacists, and laboratory technicians. Data were collected using in-depth interviews, observations, and reviews of documents. Thematic analysis of qualitative data was used.

Results: This study has found that the top-down approach used in the adoption of GoT-HoMIS in hospital has limited the preliminary preparations made by the hospital. Availability of local network connectivity, reliable electrical power supply, and perceived benefits were facilitators to the system’s use. The barriers against the use of the system were partial system implementation, shortage of ICT infrastructure, low level of ICT knowledge and skills among users, and inadequate management support.

Conclusion: This study identified a partial implementation and use of the system in the hospital, lack of adequate ICT knowledge and skills among users, and low management support at prioritizing funds for ICT infrastructure, training, supervision, and mentorship would remain as the main barriers against effective GoT-HoMIS implementation in the hospital. Therefore, enhancement of basic ICT infrastructures, regular trainings to users and strengthen system leadership, and management support of system implementation were recommended.


43

49

7. Title: Effect of cysticercosis education on improving the knowledge, attitudes, and intentions towards persons with epilepsy in Burkina Faso

Authors: Jackson, E., Dermauw, V., Millogo, A., Ganaba, R., Ngowi, H.A., Dorny, P. and Carabin, H.

Abstract

Discrimination and stigmatization against persons with epilepsy (PWE) create a heavy burden among people with neurocysticercosis-associated epilepsy. This burden is often not addressed by programs that seek to control Taenia solium cysticercosis/taeniosis. A cluster randomized controlled trial was conducted in Burkina Faso to evaluate the effectiveness of a drug-free community-based intervention in reducing new infections through educating participants about how T. solium is transmitted and promoting avoidance of risky behaviours that may lead to infection. Although the education material did not target epilepsy stigma specifically, it did describe seizures as a possible consequence of infection and thus it may affect people’s knowledge, attitudes, and intentions towards PWE. Fifty-eight villages in three provinces endemic for T. solium were block-randomized to receive the intervention (n=29) or act as controls (n=29).

Our data are from a visit 18 months after randomization when 80 people from each of the participating villages were invited to answer 24 questions about knowledge, attitudes, and intentions regarding PWE. Initial univariate analysis was performed using t-tests, chi-square analysis, and ANOVA. Consenting participants (n = 4069) had poor knowledge of epilepsy (median score 50%), believed that having epilepsy negatively affected a person’s ability to live a normal life (i.e. poor attitude; median score 37.5%), and did not intend to socialize with PWE (median score 16.7%). Younger participants and participants with more education had better knowledge, attitudes, and intentions. Male participants scored higher than female participants did on attitudes and intentions. Relative wealth did not significantly affect knowledge, attitudes, or intentions. Participants who received the intervention demonstrated a significantly higher level of knowledge overall than those who had not, although the effect was not visible on any one question when results were adjusted for multiple comparisons. The intervention did not significantly affect people’s attitudes and intentions towards PWE. Different patterns were observed in the three provinces.

This study demonstrated that PWE still faces considerable levels of stigma in Burkina Faso. As noted in the previous studies, the targeted interventions are needed to reduce the high level of stigmatization that PWE face in these areas.


44

50


E2. Policy Generation, Implementation, and other Cross-cutting Issues, continued

Keynote Prof. Samson Mukaratirwa

Presentations:

1. Title: New WHO Roadmap for Taenia solium control

Authors: Abela-Ridder, B. and Donadeu, M.

Abstract

The World Health Organization has been developing the 2030 roadmap for neglected tropical diseases (NTDs), which includes Taenia solium. Considerable, however uneven progress has been made in the fight against NTDs. The furthest progress has been among those NTDs that have had sustained development partner support and medicine donations. To sustain the gains and accelerate progress across the NTDs, concerted action that will build on the progress of the last decade and scale up where possible is required across sectors.

The target for T. solium taeniosis/cysticercosis in the new roadmap is to increase progressively the number of countries that are implementing intensified control measures in hyperendemic areas, with targets of 4 countries implementing them by 2023, 9 countries by 2025, and a total of 17 countries by the year 2030.

As a preparation to achieve these targets, new indicators for T. solium have been developed, to facilitate a uniform reporting from the countries, and to be able to report the related mega-data. The country indicators include epidemiological indicators and control program indicators. At the same time, it is important to define the thresholds to trigger interventions and to define hyper-endemic areas. The details will be presented at the meeting.

The roadmap has also identified the unique set of critical actions required for each disease to achieve the targets, which for taeniosis/cysticercosis include the diagnostic needs and increased advocacy. Another gap is the understanding of cost versus the benefit of T. solium interventions of control programmes. The new roadmap is a shift towards impact measure, holistic platform approaches, and country ownership.


45

52

3. Title: Integration mechanisms in human and animal health surveillance systems: challenges and opportunities in addressing global health security threats - a systematic review

Authors: George, J., Mremi I., Häsler, B., Sindato, C., Mboera, L., Rweyemamu M. and Mlangwa, J.

Abstract

Background: Health surveillance is an important element of disease prevention, control, and management. During the past two decades, there have been several initiatives of integrating health surveillance systems using various mechanisms ranging from integration of data sources to changing organizational structures and responses. The need for integration is justified by increasing demand for joint data collection and use, and preparedness for emerging infectious diseases. The objective of this study was to review the existing integration mechanisms in human and animal health surveillance systems and identify their contributions to strengthening surveillance systems attributes.

Methods: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) 2015 checklist. Peer-reviewed articles were searched from PubMed, HINARI, Web of Science, Science Direct, and advanced Google search engines and through the manual search for an unlimited period up to 2018. Criteria for studies were systematically reviewed to identify integration mechanisms and how they addressed surveillance attributes and meet the International Health Regulations capacities for timely detection and response to the disease outbreaks.

Results: One hundred and two (102) publications were identified and categorized into four pre-set integration mechanisms, interoperability (35), convergent (27), semantic consistency (21) and interconnectivity (19). Most integration mechanisms focused on sensitivity (45/102), timeliness (42/102), and data quality (24/102) and acceptability (18/102) of the surveillance systems. Generally, the majority of the surveillance systems integration focused on infectious diseases and all-hazards. Through integration, sensitivity and data quality of the surveillance systems have reached 79.6 and 87 percent, respectively, while timeliness has improved by 77.8%.

Conclusion: Interoperability and semantic consistency are the common integration mechanisms in human and animal health surveillance systems. Surveillance systems integration is a relatively new concept but has made improvements in strengthening surveillance attributes though with a limited focus.


46

53

F. Digital Health

Mini keynote Dr Felix Sukums

Presentations:

1. Title: Digital health information in Iringa, Tanzania: development, provision and testing the effect of digital cysticercosis/taeniosis messages on rural communities

Authors: Holst, C., Kajuna, F., Ngowi, H., Sukums, F., Radovanovic, D., Mansour, W., Mwakapeje, E., Diep, L.M., Kebede, T. A., Isabwe, G.M.N., Noll, J., Ngowi, B. and Winkler, A.S.

Abstract

Introduction: The expansion of digital technologies and global interconnectedness has a significant potential of accelerating progress towards achieving the health-related Sustainable Development Goal 3 at a global level, which includes access to free health information and education. This study, a health component of the innovation project Non-discriminating access for Digital Inclusion (DigI), aims at contributing to the prevention of Taenia solium cysticercosis / taeniosis (TSCT), among other diseases, by increasing health knowledge related to the zoonosis.

Materials and Methods: Digital health messages on TSCT developed by the DigI-group are addressing prevalence, transmission, symptoms, treatment, and prevention of the targeted diseases. A two-armed controlled study with 600 randomly selected participants is currently ongoing to measure the uptake and retention of health knowledge on TSCT, pre and post the digital health intervention. Three hundred (300) participants in the intervention group were asked TSCT questions in April / May 2019, before they were exposed once to a three-minute long animated video. The same TSCT knowledge questions were thereafter immediately repeated, and three months later, the identical health knowledge questions were repeated once again. The next follow-up surveys are planned in six months and post-intervention in 12 months.

Results: The preliminary finding supports the hypothesis that the digital health messages increase health knowledge related to TSCT. In the intervention group, prior to exposure, only 54 participants (18%) reported YES to the question whether they thought a human being could be infected with cysticercosis. Immediately after the exposure, 260 participants (87%) reported YES to the same question. Two hundred and sixty-one (261) participants (87.5%) in the same group initially reported that they did not know how a person could acquire pork tapeworm. Immediately after the exposure, 256 participants (86%) reported that pork tapeworm could be acquired by consuming raw or undercooked pork.

Discussion: We anticipate that providing health messages in a digital format will increase health-related knowledge, which would lead ultimately to the adaptation of health seeking and preventive behaviours. The digitization of health information toward clients may contribute to the strengthening of health systems, especially in low-income economy settings.


47

54

2. Title: The “Vicious Worm”: can the Taenia solium health education tool be used among meat inspectors and slaughterhouse workers in Zambia?

Authors: Vaernewyck, V., Mwape, K.E., Mubanga, C.M., Phiri, I.K., Dorny, P., Gabriël, S. and Trevisan C.

Abstract

Introduction: Taenia solium or the so-called pork tapeworm is a zoonotic parasite that is endemic in many low-income developing countries, including Zambia. It causes diseases in humans and pigs, resulting in a significant socioeconomic and disease burden in endemic areas. Lack of knowledge is a recognized risk factor and targeted health educational interventions have achieved the reduction in parasite transmission and disease occurrence. ‘The Vicious Worm’ is a computer-based health educational tool aiming at providing evidence-based knowledge about T. solium. Previous studies found a good effect of the program on knowledge uptake by professionals in health- and agriculture sectors (Mbeya Region, Tanzania) and school-aged children (Eastern Province of Zambia). This study aimed at evaluating ‘The Vicious Worm’ as health education tool for meat inspectors and slaughterhouse workers in Zambia.

Materials and Methods: The study was conducted between March and April 2019 in Lusaka and Katete, Zambia. Half-day educational workshops using ‘The Vicious Worm’ were organized with follow-up visits after three weeks. Questionnaires were administered before, and after the educational component and at the follow-up visit to determine the program’s impact on knowledge uptake and retention. Focus group discussions were conducted during the follow-up visit to assess the participants’ attitude towards the program.

Results/Discussions: About 47 study subjects (43 males and 4 females) participated: with an average age of 36 years (ranging from 22 to 52 years). The study subjects comprised of slaughterhouse workers, pig traders, and butchers/slaughterers. Baseline knowledge of T. solium was quite high (average score 63%). Overall, the participants’ knowledge was significantly improved immediately after and three weeks after the workshop compared to the baseline knowledge. The focus group discussions revealed a positive attitude towards the program. We conclude that ‘The Vicious Worm’ may be a useful educational tool to target slaughterhouse workers, pig traders, and butchers/slaughterers. We consequentially recommend its inclusion in integrated T. solium interventions in the future.


48

55

3. Title: Creation of online videos for the Virtual One-Health Centre: a report of CYSTINET-Africa, a multidisciplinary research consortium for Taenia solium taeniosis/cysticercosis

Authors: Knobloch, J., Schmidt, V., Ngowi, B., Sikasunge, C., Prazeres da Costa, C., Ngowi, H, Brügge, B. and Winkler, A.S.

Abstract

Introduction: In CYSTINET Africa, a multidisciplinary One-Health network with a focus on Taenia solium taeniosis/cysticercosis, capacity building represents a key success indicator for the project outcome. To facilitate knowledge exchange amongst members of the network and other stakeholders the Vision of the Virtual One-Health Centre (VOHC) has been established. The VOHC should allow the creation of online lecture material and provide a common ground for the recording, post-production, and distribution of online videos. We provide an overview of cost assumptions for video recording equipment, highlight our training process of video recording experts towards partner institutions and list key components and aspects of the video recording and postproduction video process.

Methods:

First, the essential video equipment for recording needs to be procured and costs need to be estimated. The following equipment has been found to be the minimum requirement for a consistent recording setup:

1x Video camera including storage media 1x Wireless audio setup including microphones and transponders 2x Main LED lights including stands as well as a green screen background 1x Laptop for video post-production 1x The Adobe Premiere Software Suite 1x External Hard drive for Storage Second, for the training of additional members in recording videos it has been proven successful to follow the following steps:

• Establish and set up all the recording equipment together. While doing so, have trainees create a training manual with images of the setup steps

• Create a minimal PowerPoint presentation which is used to record a sample video of a trainee as a short self-presentation (name, role inside the project)

• Record the determined trainee with the camera while simultaneously recording a screencast of the PowerPoint presentation created

• Installing and launching Adobe Premiere, while highlighting the key aspects of Adobe Premiere (Green Screen Features, Splitting, Cutting and Blending of Video parts, Audio synchronization based on the camera and PowerPoint recording)

• Exporting and storing the final video on the external storage

Third, for the creation of online videos for a unified network, presentation templates and style guides have been created. Those templates focus on the placement of the speaker during certain presentation slides as well as provide a common layout including fonts and logos to assure the teaching material is consistent.

The presentation created should not be longer than 20 minutes in time as studies have shown a limited capacity of continuous attention span in humans.

For the post-production video processing it is important to have a computer able to handle video manipulation as well as running the Windows or Macintosh operating system to allow Adobe Premiere to be executed.


49

56

Results: Since the establishment of the VOHC recording centres, we were able to record 4 videos, from 3 different institutions based on a common lecture curriculum. These videos will be gathered until the final decision for its distribution will be made. In addition, cost estimates to establish the individual recording studios can be given and best practice approaches in personal training have been established.

Conclusion: With the right equipment and guidance from experts we were able to train already two of the three partner institutions planned. Using one-week workshops for training turned out to be a very efficient way to fulfil our capacity building plans and we are looking forward to recording more videos in the future.

Morogoro, Tanzania



Munich, Germany






50

57

4. Title: Mobile phone data for helping control epidemics

Authors: Rubrichi, S. and Le Quentrec, E.

Abstract

Epidemics represent an important healthcare challenge worldwide. In a world that is so densely populated and more interconnected than ever, it makes increasingly easier for pathogens to propagate. Approaches that can rapidly target subpopulations for surveillance and control are critical for enhancing containment and mitigation processes.

The key to effectively control epidemics is understanding their dynamics and anticipating the possible implications. However, modelling the inherent complexity of disease spread process represents an ever-evolving challenge, requiring continuing efforts at several levels and across a broad range of disciplines. In particular, human behaviour factors, like mobility and social interactions, are crucial drivers for disease transmissions, as these can substantially alter the probability of encounters, patterns of exposure, and the likelihood of disease propagation.

Human hosts may in fact carry parasites. People can be exposed to parasites while visiting endemic regions and import the parasites back to their home communities; also, if infected, they can contribute to contamination while traveling outside their home communities. Both mechanisms are expected to favour parasite dispersion and may even introduce disease into areas that were previously disease-free. Indeed, crucial elements for strategic planning, outbreak preparedness and response require knowledge of the mobility patterns.

Modern epidemiology has recognized the increasing importance of such factors and, as a consequence, they are now at the centre of disease dynamics and control investigations.

Mobile phone data have recently offered a valid opportunity to sense individual behaviour in many aspects of daily life. Mobile phones have been one of the fastest growing technologies over the last decade, reaching urban and rural populations across all socio-economic spectra, all over the globe. Associated data, so-called call detail records (CDRs), are automatically generated by phones and recorded at large-scale by carriers for billing purposes, providing extremely rich information on individuals’ displacements and communication activities.

We here show how mobile phone data can be effectively exploited to facilitate our understanding of individuals’ spatial behaviour and its relationship with the risk of infectious diseases’ contagion. And how they hold promise for developing effective mitigation strategies to support decision-making during country-level epidemics


51

Morogoro, Tanzania



Munich, Germany






52

ABSTRACTSPOSTER PRESENTATIONS


53

58

1. Title: Prevalence and determinants of Taenia solium and other helminths among people living with HIV and HIV negative individuals in Southern Highlands of Tanzania

Authors: Nanyaro, M.W., Mahande, M., Mfinanga, G. and Ngowi, B.

Abstract

Background: Helminths and HIV co-infection is one of the unprioritized co-morbidity due to helminths being a neglected tropical disease. The HIV pandemic remains a public health concern in resource-limited settings of Sub-Saharan Africa, an area overlapping with increased occurrence of Taenia solium and soil transmitted helminths.

Objective: To determine the prevalence, risk factors and mediating effects of risk factors of Taenia solium and soil transmitted helminths among people living with HIV in the Southern highlands of Tanzania.

Methods: This is a cross-sectional study conducted in the Southern Highlands of Tanzania from June 2018 to January 2020. Data collection is ongoing in Chunya District Hospital, Mbeya region and Tosamaganga District Hospital, Iringa region. Study participants were recruited using convenient sampling technique. The study population includes PLHIV attending Care and Treatment Clinics (CTC) in Chunya and Tosamaganga hospitals.

Intended use of the results: The results of this study will give a baseline information on the burden and determinants of Taenia solium and soil-transmitted helminth infection in PLHIV at the species-specific level. Understanding the mediation effect of the Taenia solium and soil-transmitted helminths infection risk factors would be useful to health administrators when planning for interventions aiming at controlling neglected tropical diseases. The results would also contribute towards realizing the London Declaration of Neglected Tropical Diseases and WHO NTD Roadmap 2021-2030 goals in HIV/AIDS endemic areas such as Southern Tanzania.


54

59

2. Title: The impact of increasing Albendazole regimen on elimination of Taenia solium cysticercosis in human and porcine in endemic areas, Tanzania

Authors: Bandi, V., Kumalija, M., Massanga, P., Chilongola,J., Mpolya, E., Ngowi B. and Vianney, J.

Abstract

Introduction: The control of soil-transmitted helminths in Tanzania has been practiced through the annual Mass Drug Administration (MDA) that provides albendazole to individuals residing in endemic areas. However, the prevalence of Taenia solium cysticercosis in these endemic areas represented by the Mbulu District, in Manyara region has remained high. This study is aimed at examining the efficacy of MDA on this parasite. The study seeks to determine the right albendazole regimen intervals per year, and that can eliminate Taenia solium cysticercosis in endemic localities, represented by the Mbulu District in Manyara region, Tanzania.

Methodology: This study will take a minimum of one year. Thirty clusters will be involved; each cluster is a village of a maximum of 1,500 eligible individuals for intervention. Three groups of thirty clusters each will be formed. Each group will receive albendazole treatment at different intervals per year. The control group will receive albendazole as per regular MDA, while the two intervention groups will receive the drug two or three times per year. The study population includes humans, where, a maximum of 15eligible persons per cluster will be recruited as well as a maximum of 20 pigs per cluster. The study will examine whether the proposed albendazole frequency per year eliminates the infection and or prevent infection and re-infection. The presence of T. solium antigen, T. solium antibody, or taeniosis among individuals will be examined using the serum and/or urine collected from all groups under study. Meanwhile, the concentrations of levels of haematological, biochemical and serological in relation to the number of Taenia solium cysts in the human brain will be examined. Lastly, comparative Taenia solium diagnostic tests will be performed to determine their differential sensitivity and specificity.

Conclusion: The results of this study will shed light on the control and /or elimination of Taenia solium infections. The findings will be communicated to the study participants and the scientific community through publications and the Ministry of Health through the National Institute for Medical Research; Neglected Tropical Diseases control program, Tanzania Medicines and Medical Devices Authority, and the CYSTINET-Africa scientific community.


55

60

3. Title: Investigation of pig breed as a genetic determinant to the susceptibility of Taenia solium infection using sentinel pigs

Authors: Mwenda, R., Sikasunge, C. S., Mwape, K.E., Sitali, M., Schmidt, V., Winkler, A. S. and Phiri I. K.

Abstract

Background: Taenia solium cysticercosis still remains a neglected public health problem in developing and some developed countries. In many developing countries, cysticercosis seriously affects human health and pig rearing thereby leading to increased economic loses through high treatment costs for humans and carcass condemnation among pig farmers. In regions where cysticercosis is endemic such as Zambia, very little is known about the transmission dynamics of the disease associated with biological factors such as genetic makeup in order to allow effective control interventions to be fully evaluated. Sentinel pigs have been used in assessing the role of biological factors that may affect susceptibility of T. solium infection such as age and sexual hormones. Although their use to monitor disease in field conditions has been less frequent, sentinel pigs are much preferred compared to experimental infection studies due to reported challenges in establishing T. solium experimental infections in pigs. Therefore, the present study will establish the relationship between pig breeds and disease susceptibility using sentinels.

Materials and methods: Three months old cysticercosis free piglets of two different breeds, namely, Nsenga (indigenous) and Large white (exotic) will be distributed to pig farmers in Gwembe District of Zambia as sentinels. The prevalence of cysticercosis in Gwembe District is estimated at about 21 percent. Based on this prevalence, 150 piglets of each breed will be used in the study. Blood will be collected from the piglets once every month for one year starting from the day the piglets are distributed for cysticercosis detection and cytokine analysis. Tongue examination will be done concurrently with blood collection.

Expected benefits of the study: The study would be useful in providing better understanding and increased knowledge on breed susceptibility to porcine cysticercosis transmission.


56

61

4. Title: Prevalence, risk factors and performance of screening tests for neurocysticercosis in epileptic patients from selected areas of screening tests for neurocysticercosis in Tanzania 2018 epileptic patients from selected areas

Authors: Lyimo, S., Matuja, W. and Premji, Z.

Abstract

Introduction: Neurocysticercosis (NCC) is a specific form of infectious parasitic disease in the central nervous system that is caused by Taenia solium, a tapeworm found in pigs and humans. NCC is an important cause of preventable and treatable epilepsy in developing countries.

Methods: A cross-sectional study was carried out in Mbulu and Kinondoni Districts of Tanzania in 2018. Sera from 724 epileptic patients were tested for circulating antigen (Ag-ELISA) and antibody (Ab-ELISA). All participants underwent Computed Tomography (CT-scan) of the brain for evidence of neurocysticercosis. A structured questionnaire was used to identify risk factors for neurocysticercosis.

Results: The overall prevalence of active cysticercosis was found in 2.1 percent (15/724), antibody-ELISA, local antigen was 20.1 percent (145/724), Ab-ELISA, pooled antigen 18.1 percent (131/724), western blot, local antigen 23.2 percent (168/724), and for western blot, pooled antigen was 7.6 percent (55/724). For Computed Tomography (CT-scan) the prevalence was 2.3 percent (17/724). Antibody-ELISA, by local antigen test has high sensitivity (83.2%), and specificity (99.1%), PPV (96.5%) and PVN (95.2%). For NCC risk factors, the age of 35 years and above had 5.5 higher chance of getting the disease (95%CI; 1.1-20.1, P=0.04). Eating of pork, (95%CI; 1.3–14.9, P=0.00), drinking of boiled water which is not boiled, (95%CI; 5.5–10.1, P=0.00), and not using latrine, (95%CI; 1.3–14.9, P=0.00). Washing hands before eating and the use of latrine had 61 and 68 percent less chance of not getting the disease respectively (P=0.01).

Conclusion: Neurocysticercosis was present in Kinondoni and Mbulu Districts, but at a low prevalence. Performance characteristics of different serological screening tests for the diagnosis of neurocysticercosis has high sensitivity (100%), and specificity (99.8%), PPV (96.5%), and PVN (95.2%) hence it can be used in the detection of NCC at acceptable levels


57

62

5. Title: Treatment of individuals living with neurocysticercosis and HIV/AIDS: a scoping review

Authors: Abraham, A., Jewell, P., Schmidt, V., Buell, K., Bustos, J., Garcia, H. H., Dixon, M., Walker, M., Basáñez, M. and Winkler, A. S.

Abstract

Background: Human neurocysticercosis (NCC) represents a neglected tropical disease caused by the zoonotic tapeworm Taenia solium. Symptoms and signs of NCC are pleomorphic with epilepsy and headache being the most common presentations. Many regions, which are endemic for NCC, are co-endemic for HIV/AIDS, yet literature on HIV and NCC co-infection is sparse, and there is no current treatment guidance for this patient group.

Methods: The aim of the study was to review the currently available literature on NCC and HIV/AIDS co-infection, with a focus on clinical characteristics, diagnostics, and treatment outcomes. The scoping literature review methodological framework by Levac et al. and PRISMA guidelines were followed. Included studies were descriptively summarized and study location was mapped by means of R.

Results: One experimental study, eleven observational studies, 20 case series/case reports reporting on 27 cases and 17 reviews or letters were identified. Of the 27 identified cases of HIV and NCC co-infection, 15 had epileptic seizures (58%), 14 headaches (54%), and 15 (58%) had focal neurological deficits. Five of these cases demonstrated a possible immune-reconstitution inflammatory syndrome (IRIS), with four presenting with new onset seizures 9-12 months after commencing ART.

Conclusions: This scoping review shows that evidence to guide treatment of NCC and HIV co-infection is lacking. High-quality studies in this particular patient group to address treatment challenges such as drug interactions as well as IRIS when starting with ART treatment are thus needed.


58

63

6. Title: Establishment and Application of Taenia solium experimental pig infection model and investigation of pig breed susceptibility to Experimental T. solium infection

Authors: Sitali, M. C., Phiri, I. K., Mwape, K. E., Mwenda, R., Schmidt, V., Winkler, A.S. and Sikasunge, C.S.

Abstract

Background: Taenia solium is a zoonotic tapeworm whose life cycle is shared between humans and pigs. Humans are final hosts while pigs are intermediate hosts. The tapeworm causes taeniosis in humans and cysticercosis in both pigs and humans. Besides pigs being infected naturally when they ingest proglottids or eggs of the tapeworm from human faeces of a tapeworm carrier, they can be experimentally infected. Pigs represent an alternative biomedical model to rodents for specific human diseases as their physiology, anatomy, pathology, genome organization, immune system, body weight and life span are more similar to those of humans.

Objectives: The aim of this study is to establish a T. solium experimental pig infection model, investigate pig breed susceptibility to T. solium experimental infection and to determine the immune response in pigs experimentally infected with T. solium proglottids or eggs.

Methodology: Three groups of 4 piglets each will be experimentally infected with a single dose of two gravid proglottids (assuming each proglottid has 60,000 eggs). The gravid proglottids will be mixed with 1kg of Dry Sow feed and then given to the pigs. Blood samples for monitoring T. solium cysticerci antigens and antibodies will be collected from each pig before infection starting from the day of infection (d0) and every week post-infection (WPI) for 4 months. At 16 WPI, all pigs will be humanely euthanized and a full carcass dissection will be performed in order to determine the success of the challenge infection and enumerate cyst numbers per pig.

Expected benefits: The study will strengthen the basic science aspect of research on T. solium cysticercosis and may contribute to ensuring sustainable and innovative basic science research in the future. It is also likely to build capacity pertaining to the transfer of the pig model to other African partners and create synergies for other parasitic animal models which are important for sub-Saharan Africa.


59

64

7. Title: Investigation of the role of insects in the transmission of Taenia solium eggs in endemic villages of Eastern and Southern Provinces of Zambia

Authors: Hachangu, A., Sikasunge, C.S., Phiri, I. K., Winkler, A.S., Schmidt, V. and Mwape, K.E.

Abstract

Background: Taenia solium cysticercosis/taeniosis (TSCT) is an emerging but neglected parasitic and zoonotic disease caused by the tapeworm T. solium. The disease is endemic in developing countries of Africa, Asia, and Latin America where pigs are raised as a food source and are kept under free-range. It causes taeniosis and cysticercosis in humans. The infection of the brain leads to neurocysticercosis (NCC) a leading cause of epilepsy in endemic countries. Zambia is endemic for T. solium and is reported to be responsible for over 50 percent of epilepsy cases. Therefore, there is an urgent need for control measures. This requires knowledge of the factors that maintain the parasite in the communities. Insects have been reported to transmit eggs of other tapeworms. These insects could possibly play a role in the transmission and maintenance of T. solium eggs in endemic areas of Zambia.

Methods: The cross-sectional field study will be conducted in Chipata and Gwembe Districts of Eastern and Southern provinces of Zambia respectively. Blowflies and dung beetles will be captured in Chipata and Gwembe Districts. The insects will be transferred to the University of Zambia for identification. After identification, the insects will be examined for the presence of cestode eggs on their exoskeleton. The flies will then be homogenized and tested for the presence of Taenia DNA and other cestodes. In an experimental study, live flies will be exposed to human stool laden with cestode eggs in a 30 x 30 x 40cm box made of plywood and wire gauze. The flies will then be examined for the presence of cestode eggs. Oviposition sites will be checked daily for the presence of cestode eggs. The flies will be homogenized and tested for the presence of Taenia DNA and other cestodes. All the collected data will be entered in an appropriate form on tablets using the KoboCollect software. The data will be analyzed in Stata and R statistical software.

Conclusion: The study will provide evidence whether or not insects should be included in the control measures of T. solium in endemic areas.


60

65

8. Title: Investigation of biomarkers in pigs naturally infected with cysticercosis after treatment with oxfendazole

Authors: Zulu, C., Phiri, I. K., Mwape, K.E., Schmidt, V., Winkler, A. S. and Sikasunge, C. S.

Abstract

Background: Taenia solium causes taeniosis in humans and cysticercosis in pigs. Humans can also acquire cysticercosis when they accidentally ingest T. solium eggs and develop neurocysticercosis (NCC) when the cysticerci lodge in the brain. Biomarkers are tools used to identify high-risk individuals; it can quickly and accurately diagnose the state of the disease, and determine treatment plans and prognoses. They are molecules released by or specific to a particular organ that can give a glimpse into the physiologic or pathologic status of that specific organ. Myoglobin, Creatine kinase (CK) and Cardiac troponins (cTn) are markers that have been used in humans to measure certain diseased states in the muscle and in the heart. Similarly, neuron-specific enolase (NSE) and S-100B are among the widely used biomarkers of brain injury in humans. Since these biomarkers have been used to study human diseases, further investigation and demonstration of these biomarkers in a pig model may provide additional supportive evidence that pigs indeed provide good models to study human diseases including cysticercosis. The objective of this study is to determine the levels of troponin I, myoglobin, and CK and to determine whether neuron-specific enolase (NSE) and S-100β are indicative of brain inflammation in pigs naturally infected with cysticercosis following treatment with oxfendazole.

Methods: Twenty positively infected pigs on tongue examination will be purchased and divided into two groups; infected and treated as well as infected and not treated (positive control). A third group of 10 cysticercosis free pigs will also be included as a negative control. Treatment will be done using oxfendazole at 30mg/kg orally as a single dose followed by weekly collection of serum and whole blood samples. Pigs will be blood sampled until 16 weeks post treatment. A necropsy will be conducted at the end of the study to determine the number of cysts.

Expected benefits of the study: Demonstration of these biomarkers in a pig model may provide an auxiliary test that could be used for diagnosis of muscular, cardiac, and brain involvement in humans with cysticercosis and for monitoring patients during treatment especially monitoring the presence and extent of brain damage during treatment in the absence of neuroimaging.


61

66

9. Title: Taenia solium cysticercosis and taeniosis in urban settings: a health-centre based study among people with epilepsy in Dar es Salaam, Tanzania

Authors: Schmidt, V., O'Hara, M., Ngowi, B., Herbinger, K., Noh, J., Wilkins, P. P., Richter, V., Kositz, C., Matuja, W. and Winkler, A. S.

Abstract

Background: In Africa, urban populations are growing rapidly which results in new implications for the transmission of infectious diseases. For the zoonotic parasite Taenia solium, a major cause of acquired epilepsy in endemic countries and the prevalence in urban settings is unknown.

Methods: The present study investigated the epidemiological, neurological, and radiological characteristics of T. solium cysticercosis and taeniosis (TSCT) in people with epilepsy (PWE) living in Dar es Salaam, Tanzania, one of the fastest growing cities in the world. About 302 PWE were recruited from six health centres in Kinondoni District of Dar es Salaam. Serological testing for T. solium cysticercosis-antigen (Ag) and -antibodies (Abs) and for T. solium taeniosis-Abs was performed in all PWE. In addition, clinical and radiological examinations that included cranial computed tomography (CT) were performed. Demographic data from study populations were collected by questionnaires, and the factors associated with TSCT were assessed. Follow up examinations were conducted in PWE with TSCT.

Results: T. solium cysticercosis-Ag was detected in three (0.99%; 95% CI: 0-2.11%), -Abs in eight (2.65%; 95% CI: 0.84-4.46%), and taeniosis-Abs in five (1.66%; 95% CI: 0.22-3.09%) of 302 PWE. Six PWE (1.99%; 95% CI: 0.41-3.56%) were diagnosed with neurocysticercosis (NCC).

Conclusions: This study shows the presence of TSCT in Dar es Salaam, but NCC was only associated with a few cases of epilepsy. The small fraction of PWE with cysticercosis- and taeniosis-Abs suggests that active transmission of T. solium plays only a minor role in Dar es Salaam. Unfortunately, a sufficiently powered risk analysis was hampered by the small number of PWE with TSCT. Further studies are required to determine the exact routes of infection and the risk behaviour of the affected individuals.


62

67

10. Title: Further confirmation of the impact of pig vaccination and oxfendazole medication in the control of Taenia solium transmission

Author: Lightowlers, M.

Abstract

The TSOL18 vaccine proved to be extremely effective in reducing Taenia solium infection in pigs given an experimental infection with the parasite’s eggs. A field trial in a cohort of animals in Cameroon found that vaccination and a single oxfendazole treatment of piglets eliminated T. solium infection in animals of 12 months of age, whereas 19.6 percent of the animals that were given the oxfendazole treatment alone were found to have T. solium infection when they were 12 months old.

The TSOL18 vaccine was subsequently developed as a registered product, Cysvax, by Indian Immunologicals Limited. Two immunizations with Cysvax are required to induce a high and long-lasting antibody titre. Investigation of the timing of the two immunizations found that excellent responses were seen even if the interval between vaccinations was 3 or 4 months. This timing fits well with the requirement for treatments to be applied in the pig population relatively frequently because of the continual introduction of newborn piglets into the population and the relatively young age at which the pigs may be slaughtered for consumption. We have now undertaken further field evaluations of vaccination and medication in pigs for the control of T. solium.

We assess a 3-monthly intervention on the pig population in T. solium endemic areas in Nepal [1] and Uganda by post-mortem evaluations carried out in slaughter-age pigs. In both trials, animals that had received the treatments were found to be completely free of viable T. solium cysts. These data confirm the potential value of combined use of Cysvax vaccination and oxfendazole treatment in the control of T. solium transmission. Our focus now is to further simplify this intervention program so as to improve its feasibility and acceptance to authorities who wish to implement T. solium control in endemic countries.


63

68

11. Title: The digitalization of health networks in sub-Saharan Africa: report of CYSTINET-Africa, a multidisciplinary research consortium for Taenia solium taeniosis/cysticercosis

Authors: Knobloch, J., Schmidt, V., Ngowi, B., Sikasunge, C.S., Prazeres da Costa, C., Ngowi, H., Brügge, B. and Winkler, A.S.

Abstract

In CYSTINET Africa, a multidisciplinary One-Health network with a focus on Taenia solium taeniosis/cysticercosis, capacity building represents a key success indicator for the project outcome. Data sharing is mandatory and is best done digitally but can be challenging in large health networks. Here, we share our own experience within CYSTINET-Africa highlighting key aspects of network digitalization in remote rural areas of sub-Saharan Africa with respect to the sustainability of the system’s setup.

Firstly, we compare different providers of data collection tools (EpiCollect [1], KoboToolbox [2], MagPi [3]) with an emphasis on data privacy regulations (DSVGO). Secondly, during data collection we follow a re-designed medical workflow for our epidemiological studies in which we use a so called “patient pass”. Thirdly, hardware and software procurement concerns are highlighted in addition to the potential infrastructure challenges.

The new DSVGO [4] influences decisions of data storage locations, its software to be used and data exchange agreements to be specified if data are transferred between multiple countries. We compare different existing software solutions for offline data collection based on their features such as creation of questionnaires, ease of use, storage and backup, data privacy concerns, license models and costs. Since data collection tools, do not typically offer workflow support for epidemiological studies, standard operation procedures (SOPs) need to be adapted to integrate seamlessly. The use of barcode labelling techniques helped to provide the needed traceability. In our scenario, blood and stool samples are mapped to a unique patient barcode to be traceable but still anonymous. To support such an approach, the “patient pass” shall minimize errors in data sample collection and handling.

To assure data access, server availability tests are established to assure server uptime [5]. Based on the results of different tests, backup servers are put in place using synchronization techniques to mirror the existing data to additional remote locations. Concerning hardware and software procurement, we advise for the international single source procurement for hardware with limited availability, while strengthening local industry for procurement of commonly available goods such as printers, computer monitors and consumable supplies.


64

69

12. Title: Control and Prevention of Taenia solium taeniosis/cysticercosis in Tanzania

Author: Boa, M. E.

Abstract

Taenia solium infections in humans and pigs are found to be endemic in most rural Tanzania; where pigs are mostly raised under the free-range system. This paper looks at various research publications from 1975 to date; and whose statistics were found to be shocking. Abattoir survey by Boa et al (1975); established the prevalence of 13.3 percent (n=83); with most of the positive pigs coming from Mbulu District. A detailed study by Ngowi et al using tongue examination method in some villages of Mbulu District showed the prevalence of 17.4 percent.

The established risk factors responsible for disease transmission were free ranging of pigs and absence of latrines in the households. Later studies by Boa et al using antigen ELISA in Chunya, Iringa Rural Districts of southern Tanzania established the prevalence of 28.0 and 10.6 percent, respectively. Risk factors were free ranging of pigs, lack of latrine in the household and home slaughter without inspection of the pork. In Songea and Mbinga Districts, the abattoir survey and tongue examination indicated the prevalence of 24.4 and 16.9 percent respectively. In Mbinga District, the risk factors were the free ranging of pigs and lack of latrine in the household. Contrasting results were found in Mgeta Division in Morogoro whereby post mortem examination of 124 carcasses, tongue examination of 690 pigs from various villages and using Ag-ELISA (n=462);established the absence of the disease in the area. the absence of the disease in the division was attributed mainly to the strict confinement of pigs in pens. Secondly, the area is densely populated with year-round cultivation of horticultural crops; thus no free space for foraging pigs. Thirdly, legislation was put in place and enforced by the local communities to restrict free ranging of pigs.

The communities in the area realized that the cost of allowing pigs to range was higher than that of total confining and feeding them. The major driving force behind raising pigs in most of these rural areas is economics. Therefore, the health risk of transmitting and getting cysticercosis is not of immediate economic importance.


65

70

13. Title: Interdisciplinary approach in cysticercosis control in Tanzania: literature review

Author: Msinde, P.

Abstract

Introduction: Cysticercosis is the parasitic tissue infection caused by larval cysts of tapeworm Taenia solium. These larval cysts usually tend to infect brain, muscles, and other tissues of the human body. Usually, a person gets the disease by swallowing eggs found in faeces of a person with an intestinal infection. Due to the zoonotic properties of Taenia solium cross-disciplinary one health approach has been adapted. Cysticercosis was included as the one of diseases that can be intervened using one health Approach. The dual impact of substantial burden in terms of human, livestock health, and economic implication to community livelihoods exacerbate the poverty cycle.

Objective: To review the multidisciplinary approach that is carried out in Tanzania and determine its implication for Taenia solium cysticercosis.

Methods: A literature review was carried out in various sources such as the ONE HEALTH STRATEGIC PLAN of Tanzania so to gain a deep insight into what Tanzania undertakes as far as cysticercosis control is concerned. All sources of information were clearly cited in the Reference section.

Results: The United Republic of Tanzania set a five years strategic plan from 2015-2020 with five thematic areas, which are training, preparedness, research, diseases surveillance, prevention and control, and coordination. Alongside these, Tanzania has established One Health Coordination Desk as part of the efforts of eliminating this disease. Tanzania is one of most studied countries in terms of epidemiology of Taenia solium in Sub-Saharan Africa. The societal cost study shows that the estimated DALYs per thousand person-years for NCC-associated epilepsy were higher than the DALYs recently estimated for other countries.

Conclusion and recommendation: Measuring and evaluating the success of control programmes remain a major issue. The intervention should focus on both human and pigs in fighting against this neglected tropical disease. Cysticercosis has both social and economic impacts mostly in rural areas where the problem is pronounced; hence, the deployment of immediate measures in these marginalized areas is highly recommended.


66

71

14. Title: Description of disease reporting systems, assessment of diagnostic capacities and existing records for Taenia solium cysticercosis/taeniosis in Tanzania

Authors: Mlowe, F. Karimuribo, E., Mlangwa, J.E.D. and Ngowi, H. A.

Abstract

Background: Cysticercosis in both pigs and human and taeniosis are two forms of a zoonotic disease caused by Taenia solium tapeworm. The disease is prevalent in low-income countries and currently is diagnosed in developed countries. There is a perceived inefficient disease diagnosis, recording, and reporting systems of both forms in Tanzania hence limiting control efforts. Successful control and eradication of the disease requires adequate personnel skills and diagnostic tools with high specificity and sensitivity, and adequate recording and reporting of the disease. This study intends to identify the challenges and the existing opportunities in the T. solium cysticercosis/taeniosis disease diagnosis, reporting, and recording systems for strategic allocation of resources of improving the disease diagnosis, recording, and timely reporting.

Methodology: A cross-sectional and qualitative study designs will be conducted in Babati, Mbulu, Kongwa, Mbinga and Nyasa Districts in Tanzania which are endemic for the disease. Ninety-eight livestock and one hundred and twenty health workers randomly selected in 5 districts will be interviewed in the study. A structured questionnaire will be used to collect data on personnel diagnostic skills, the available diagnostic tools, and processes. In depth interviews will be conducted with key informants at districts and referral hospitals to explore the processes and challenges and further guided by a checklist. Literature and secondary data on the disease in Tanzania will also be collected. Descriptive statistics will be generated using SPSS software; content analysis will be performed on the literature and key informants’ responses. The country’s disease reporting systems will be compared with the standards as defined by WHO and OIE. The usefulness of the existing records in studying the epidemiology and control of the disease will be assessed based on the structure of the data and the literature.

Expected outcomes: Study results will help in understanding the challenges and opportunities in the disease diagnosis, reporting, and recording systems and thus strategically help to allocate the resources for the control and eradication of the disease in the country.


67

72

15. Title: Developing a learning analytics dashboard for visualizing traces for learners to facilitate administrative decision making: a case of HaloStudy system in Tanzania

Authors: Sengula, A. and Sukums, F.

Abstract

The Tanzanian education system has undergone many revamps over the past years, an indication that indeed the government is working towards improving the educational standards. However, different studies have revealed that more needs to be done regarding the education system in the country especially in areas where teachers are scarce.

The use of e-learning in secondary school education has been suggested by many researchers as a viable solution to address scarcity of resources. Currently, there are different eLearning systems in use for secondary schools in Tanzania. HaloStudy, one of the popular eLearning systems for secondary schools in Tanzania, is a project funded by one of the leading Tanzanian telecommunication operators known as Halotel. HaloStudy LMS has been developed using Moodle platform, a preferred open source eLearning tool used by millions of users in the world.

Various studies carried out in Tanzania have shown that the use and readiness of e-learning in secondary schools is very high which is a factor that has accelerated Halostudy's rapid spread in secondary schools. Although Halostudy has helped many students in various ways, it is still not well utilized by teachers and other stakeholders in decision-making since it does not provide analytical visualization of student’s performance and engagement. The system lacks learning analytics dashboard, which is instrumental in decision-making and continuous improvement by disclosing patterns, trends, and associations, primarily relating to student’s performance and interactions. Analytics dashboard can be used by teachers to identify students who appear less likely to succeed academically and to enable or even initiate targeted interventions to help them achieve better outcomes.

This study will deliver a well-developed learning dashboard, which will be built as a Moodle plugin; the dashboards will present large amounts of data in a way that graphs and charts will be used for data presentation. These data can be presented in many ways, such as histograms, bubble charts, and the like.


68

73

16. Title: Epidemiological, clinical characteristics and treatment (HAART) response in HIV patients with Taenia solium neurocysticercosis from Southern Highlands, Tanzania

Authors: Makasi, C., Stelzle, D., Schmidt, V., Ngowi, B. and Winkler, A.S.

Abstract

Background: Cysticercosis/Taeniosis is a neglected tropical disease caused by the pig tapeworm (T. solium). This zoonotic disease affects both human and porcine health. In its most severe form, patients develop cysts in their brain after ingesting T. solium eggs. This is called Neurocysticercosis (NCC), which is one of the leading causes of seizures and epilepsy in developing countries.

The increased frequency of Human Immunodeficiency Virus (HIV) infection in endemic areas of cysticercosis needs much attention since it is not clearly known if the burden of NCC differs between people living with HIV (PLWHIV) compared to HIV negative individuals. This study aims at elucidating the burden and disease manifestation of NCC among PLWHIV as opposed to people who are HIV negative. In addition, the treatment (HAART) response in HIV patients with T. solium neurocysticercosis will be examined.

Methodology: This study will be carried out in Chunya (Mbeya) and Iringa (Southern Highlands of Tanzania). We will use a paired cross-sectional design whereby PLWHIV from the health facilities (HIV Care and Treatment Centre and metal health clinics) will be matched with HIV negative individuals from the communities of Chunya and Iringa. The paired cross-sectional study will maximize the power of detecting differences between the PLWHIV and their HIV-negative match. With a derived baseline scenario of 32 percent discordant pairs, we would have a power of 85 percent to detect the prevalence proportion ratio of 1.4; we would have powers of 77 and 89 percent to detect the prevalence proportion ratio of 1.8 and 2, respectively, with 9 percent of the pairs being discordant. The power increases as the proportion of discordant pairs increases. Therefore, the study will recruit 1000 pairs (n=1,000 PLWHIV and 1,000 matched HIV-negative individuals).

Conclusion: The obtained results will show the burden of NCC in PLWHIV and determine associated factors. It will also show the clinical course and immunological response of PLWHIV and NCC that are initiated on HAART. This will facilitate evidence-based implementation of management and designing of intervention strategies against NCC. It will also lead to the preparation and implementation of better management protocol for both conditions in co-existence (i.e. NCC and HIV).


69

74

17. Title: Assessment of contamination health risks of intestinal parasitic helminths associated with reused wastewater for vegetable irrigation in Mbeya, Tanzania

Authors: Msoffe, V., Mkupasi, E., Misinzo, G., Ngowi, B., Ngowi, H., Gabriël S. and Johansen, M.V.

Abstract

Reuse of wastewater for vegetable irrigation is becoming common in developing countries due to its easy accessibility, fertilizing elements for better growth and survival of crops that increase yield. Regardless of these advantages, this practice plays as important risk factor in the transmission of intestinal parasitic helminths, if no proper management is considered in farming practices and wastewater treatment. Hence, this study was designed to assess farmers’ awareness, perceptions, managerial and consumption practices regarding vegetables irrigated by reused wastewater. In addition, this study was conducted to identify intestinal parasitic helminths eggs concentration and profile from field samples of wastewater and vegetables.

Sociological survey data were collected from 61 purposively sampled smallholder vegetable farmers using semi-structured questionnaires. Fifty six (56) samples of effluent water from wastewater treatment ponds (WWTP), polluted stream water (PSW) and reused wastewater-irrigated vegetables were collected for parasitological examination. The parasitological examination was conducted using the floatation method adopting a modified Bailenger protocol with zinc sulphate (1.3 specific gravity). The differences in farmers’ awareness and the perception levels were analyzed by multivariate analysis of covariance (MANCOVA). Additionally, the association between demographic factors and vegetable consumption practice were analyzed using multivariate linear regression analysis model.

The results indicate that there was a statistically significant difference (P<0.05) between participants’ levels of education and time involved in crop production. In addition, the education level of the participants was significantly (P<0.05) influencing the consumption practices. Besides, the analysis of parasitic helminths data showed that, 88 percent WWTP, 78.6 percent PSW, and 75 percent vegetables are contaminated with intestinal parasitic helminths eggs with the mean concentration of 1.14 eggs/L, 0.667 eggs/L and 3.3 eggs/100 g respectively. Intestinal parasitic helminths found were Ascaris sp., Hookworms, Taenia sp., Trichuris sp., Strongyloides sp. Enterobius sp., and Hymenolepsis sp. PCR analysis revealed that 26.7 percent of the samples were contaminated with T. solium eggs. It is concluded that polluted streams channelled with effluent water from Kalobe WWTPs is contaminated with higher levels of intestinal parasitic helminths eggs than the recommended levels by WHO. However, the majority of farmers are somehow aware of the health risk resulting from the consumption of vegetables irrigated with reused wastewater.


70

75

18. Title: Establishing a serum bank of confirmed cysticercosis positive and negative samples

Authors: Karani, M., Fèvre, E.M. and Cook, A.

Abstract

Introduction: Porcine cysticercosis is a neglected zoonotic disease caused by Taenia solium. A recent study estimated the prevalence at 37.6 percent in western Kenya. The existing serological tests that detect circulating T. solium cyst antigens have poor specificity thus limiting their diagnostic capacity. The fine carcass dissection method is considered a gold standard for detecting porcine cysticercosis. Objective: The aim of this project is to collect a bank of blood and serum samples from pigs confirmed to be cysticercosis positive and negative via fine dissection. These samples will then be used for future diagnostic test validation.

Materials and methods: Twelve slaughterhouses have been recruited from two counties in western Kenya with the help of the County Veterinary officials. Pigs are sourced through local butchers and purchased at the market rate. Each pig is identified, and relevant meta-data recorded. Blood samples are collected from the jugular vein and lingual palpation performed peri-mortem. Following slaughter, the carcass is weighed and dressed following a specific protocol. The carcass and organs are transported to the field lab in Busia and refrigerated. Fine dissection is performed on the carcass and organs in slices approximately 3mm and checking for the presence of cysts. All relevant data are recorded electronically, while the serum and uncoagulated blood are frozen for future diagnostic work.

Results: We have so far processed fourteen carcasses, and all were confirmed of having no cysts. This work poses challenges especially with lack of supply in the market. Pigs are purchased at market rate although the pricing is usually not fixed thus making the process of bargaining difficult. The average dissection time is four hours. We project to dissect 110 pigs in the next 6 months.

Conclusion: At the end of this project, the bank with confirmed cysticercosis positive and negative blood and serum samples will be established. These results will be made available via open access so as to expedite the validation of diagnostics kits with higher specificity. This, in turn, will aid quicker and more accurate diagnosis of the disease.


71

76

19. Title: Community-based health education package for the control of Taenia solium cysticercosis in Tanzania

Authors: Nyangi, C., Mkupasi, E. M., Mahonge, C., Ngowi, H.A. and Winker, A.S.

Abstract

Background: Current Taenia solium cysticercosis (TSC) control relies on, among other things, proper pig management, sanitation/hygiene, and meat inspection. However, these control methods alone seem to have limited effect. Few studies conducted so far in other parts of the world indicate that a health education package developed and implemented with community participation can address the problem. However, there is no community-based health education package in place to address TSC in sub-Saharan Africa including Tanzania. The present work developed a community-based health education package for controlling TSC in Mbulu, Mpwapwa, Mbinga and Rungwe Districts.

Methods: To identify potential TSC infection risks and formulate key messages for the development of health education package an extensive community-based mixed methods approach was used. The formative research method was used to develop the health education package. A questionnaire survey of 483 households was conducted to assess knowledge, attitude, and practices (KAP) regarding TSC. For triangulation purposes, 11 Focus Group Discussions (FGDs) and 29 in-depth interviews (IDIs) of key informants were conducted. Data from the questionnaire survey were analyzed using IBM SPSS software.

Results: Majority of the respondents were not aware of taeniosis transmission (n=374, 77%); human cysticercosis (HCC) (n=462, 96%); porcine cysticercosis (PC) (n=267, 55%); and epilepsy (n=392,81%); and on the health effects of tapeworm (n=256, 53%); and HCC (n= 448, 93%). Awareness on the control measures was very low for tapeworm (n=379, 78%); HCC (n=458, 95%); and epilepsy (n=352, 73%). The general knowledge of transmission, health effects, prevention, and treatment of TSC was poor across all four districts. Significant risk practices, include drinking untreated water (p=0.001), free-range pig management (p= 0.032), not washing hands after using toilets (p=0.024), and undercooking of pork (p= 0.000). Accordingly, a community-based education package that comprised the following components was developed: (1) KAP of transmission, health effects and control measures, (2) proper pork cooking and general food handling practices, (3) pig husbandry practices, (4) general sanitation/hygiene practices.

Conclusions: The findings indicate low knowledge regarding TSC in the community and the presence of infection risk practices for TSC endemicity. Therefore, a community-based health education package was developed using the key messages formulated from the potential infection risk.


72


73

Morogoro, Tanzania



Munich, Germany






74


75


76

CYSTINET-Africa NetworkCoordination OfficeSokoine University of AgricultureDepartment of Veterinary Medicine and Public HealthP.O. Box 3021Morogoro, Tanzania

www.cysti.net

@ cystinet

@ cystinet_Africa

[email protected]

BAJUTA INTERNATIONAL (T) LTDManufacturersandDistributorsofAgrochemicals,VetDrugs,

Seeds,EquipmentsandFertilizers

Head Office: P.O.Box12103,Arusha,Tanzania

Tel:+255272508811|Fax:+255272548829Email:[email protected]:www.bajuta.co.tz


Documents

ABSTRACT BOOK - CYSTINET-Africa Conference...1 ABSTRACT BOOK Arusha - Tanzania CYSTINET-Africa: Cysticercosis/Taeniosis Conference 2019 26-28 November 2019 MOZAMBIQUE INSTITUTE FOR